PORTUGAL HEALTH SATELLITE ACCOUNTS

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Methodological Report Definitive Results

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PPrreeffaaccee:: The pilot project “Health Accounts for Portugal” described in this document results

from a partnership between the following national organizations at the level of

coordination and compilation:

National Statistical Institute - NSI (INE)

Health Financing and Computer Management Agency – (IGIF)

Directorate-General of Health – (DGS)

Directorate-General of Studies and Forecasts of the Ministry of Finance and Public

Administration – (DGEP)

The creation of the two working groups, the coordination and the operational group,

involves representants from the above-mentioned institutions:

The working group is responsible for the compilation of the project and comprises

the following persons:

Drª. Isabel Quintela (INE);

Drª. Suzete Tranquada (IGIF);

Dr.ª Alexandra Carvalho (IGIF);

Drª. Teresa Martins (DGS);

Dr. José Martins (DGS);

Engª Ingrid Almeida (DGEP).

The coordination group is responsible managing and planning of the project and

includes the following representants:

INE- Prof. Doutor Fernando Chau / Drª. Alda de Carvalho/ Dr. Daniel Santos

Drª Emília Saleiro;

IGIF- Dr. Aldino Salgado / Dr. Manuel Teixeira;

DGS- General-Director represented by Drª Teresa Martins;

DGEP- General-Director represented by Engª Ingrid Almeida.

We also would like to thank:



All Institutions and enterprises for supplying all the primary data;

To Dr. Helder Reis, Adviser of the Secretary of State of The fiscal Afairs;

To the following colleagues in the National Accounts (Supply and Use Table

and Institutional Sectors) that have directly contributed to make available the

integrated estimates, namely:

o Drª Susana Antunes (INE);

o Drª Dinora Nicolau (INE);

o Drª Noémia Goulart (INE);

o Drª Ema Marques (INE);

o Drª Vanda Dores (INE);

o Drª Teresa Hilário (INE).



CCOONNTTEENNTTSS ACRONYMS AND ABBREVIATIONS......................... .......................................................................... 5

INTRODUCTION .................................................................................................................................... 7

CHAPTER I – OVERVIEW..................................................................................................................... 8

1.OBJECTIVES.................................................................................................................................. 7

2. BODIES INVOLVED....................................................................................................................... 8

CHAPTER II – METHODOLOGY........................... .............................................................................. 10

1. THE INVENTORY OF TH E HEALTH SATELLITE UNIVERSE ................................................... 12

2. THE THREE-DIMENSIONAL CLASSIFICATION OF THE HEALTH SATELLITE ACCOUNT

UNIVERSE ....................................................................................................................................... 16

Classification of units by healthcare provider (ICHA-HP) ............................................................ 17

Classification of sources of healthcare funding (ICHA-HF) ......................................................... 23

The functional classification of health care (ICHA-HC) ............................................................... 23

3. COMPILATION OF DATA ............................................................................................................ 23

Basic concepts............................................................................................................................. 23

Estimating healthcare expenditure by healthcare provider.......................................................... 23

Estimating healthcare expenditure by healthcare financer.......................................................... 23

Estimating healthcare expenditure by healthcare function (including related functions)............. 23

Transfer matrices ......................................................................................................................... 23

4. CONSOLIDATION OF RESULTS AND COMPLETION OF SHA TABLES 2 TO 5 ...................... 23

Description of the tables .............................................................................................................. 23

1st. Phase: Determining the equilibrium values of production and financing for each provider and

financing agent (Table 3) ............................................................................................................. 23

2nd. Phase: Determining expenditure values by healthcare function and by provider type (Table 2)

..................................................................................................................................................... 23

3rd Phase: Determining the funding values by healthcare function (Tables 4 and 5): ................ 23

5. LIMITATIONS............................................................................................................................... 23

6. DIFFERENCES BETWEEN THE NATIONAL ACCOUNTS AND THE HEALTH SATELLITE

ACCOUNT........................................................................................................................................ 23

CHAPTER III – FUTURE PROJECT DEVELOPMENTS.......... ........................................................... 23

ANNEXE 1: TABLE 2. CURRENT EXPENDITURE ON HEALTH BY FUNCTION OF CARE AND

PROVIDER INDUSTRY ....................................................................................................................... 23

ANNEXE 2: TABLE 3. CURRENT EXPENDITURE ON HEALTH BY PROVIDER INDUSTRY AND

SOURCE OF FUNDING....................................................................................................................... 23



ANNEXE 3: TABLE 4. CURRENT EXPENDITURE ON HEALTH BY FUNCTION OF CARE AND

SOURCE OF FUNDING....................................................................................................................... 23

ANNEXE 4: TABLE 5. TOTAL EXPENDITURE ON HEALTH INCL UDING HEALTH-RELATED

FUNCTIONS......................................................................................................................................... 23

ANNEXE 5: ICHA-HP – CLASSIFICATION OF HEALTHCARE PR OVIDERS.................................. 23

ANNEXE 6: ICHA-HF – CLASSIFICATION OF SOURCES OF HE ALTHCARE FUNDING.............. 23

ANNEXE 7: ICHA-HC – CLASSIFICATION OFHEALTHCARE FUN CTIONS................................... 23

ANNEXE 8: SNAP (BASE 95) INSTITUTIONAL SECTOR NOMEN CLATURE.................................23

ANNEXE 9: CLASSIFICATION OF INDIVIDUAL CONSUMPTION BY PURPOSE (COICOP)......... 23

ANNEXE 10: CLASSIFICATION OF FUNCTIONS OF GO VERNME NT (COFOG) .......................... 23

ANNEXE 11: HEALTHCARE EXPENDITURE BY SOURCE OF FUND ING...................................... 23

ANNEXE 12: DECISION-MAKING ALGORITHM: DISTINCTION B ETWEEN MARKET PRODUCERS,

PRODUCERS FOR OWN FINAL USE AND NON-MARKET PRODUCER S IN RELATION TO

INSTITUTIONAL UNITS ................................ ...................................................................................... 23

ANNEXE 13: COMPARISON OF BUSINESS ACCOUNTS AND ADMI NISTRATIVE DATA WITH

EAS95 NATIONAL ACCOUNTS CONCEPTS ................... ................................................................. 23

ANNEXE 14: DL 442-A/88 LIST (IRS ORIGINAL)......... ..................................................................... 23

ANNEXE 15: ALGORITHMS USED TO CALCULATE EXPENDITURE ON HEALTH CARE BY

PROVIDER INDUSTRY ....................................................................................................................... 23

ANNEXE 16: ATTRIBUTION OF EXPENDITURE ON HEALTH CAR E BY PROVIDER INDUSTRY

AND SOURCE OF FUNDING .............................................................................................................. 23

ANNEXE 17: SOURCES OF INFORMATION USED IN ATTRIBUTI NG EXPENDITURE ON HEALTH

CARE BY PROVIDER INDUSTRY AND BY FUNCTION.......... .......................................................... 23

ANNEXE 18: SOURCES OF INFORMATION USED TO ALLOCATE HF BY HC IN RELATION TO

DIFFERENT HPS ................................................................................................................................. 23



AACCRROONNYYMMSS AANNDD AABBBBRREEVVIIAATTIIOONNSS ADMA Navy sickness social insurance scheme

ADME Army sickness social insurance scheme

ADMFA Army sickness insurance scheme

Air Force sickness social insurance scheme

ADSE Social insurance scheme for public sector workers and civil servants

CAE Portuguese Classification of Economic Activities

CNLSida National Committee for the Fight Against AIDS

DGEP Directorate-General of Studies and Forecasts of the Ministry of

Finance and Public Administration

EOEP State and Other Public Entities

EAS 95 European Accounts System 1995

EU European Union

FUE Statistical units file

GDP Gross Domestic Product

GFCF Gross Fixed Capital Formation

SBS Structural Business Survey

IAPI Annual Survey on Industrial Production

ICHA International Classification for Health Accounts

IGIF Health Financial and Computer Management Agency

INE National Statistical Institute

INFARMED National Pharmacy and Medicines Institute

IPS Portuguese Insurance Institute

IPSSs Private social solidarity institutions



IRC Corporation tax

IRS Income tax

NHS National Health Service

NPIs Non-Profit Institutions

NPISHs Non-Profit Institutions Serving Households

NPMs Non-Prescribed Medicines

NPC Tax number

NPCN National Accounts Product Nomenclature

NUTS Nomenclature of statistical territorial units

OECD Organisation for Economic Co-operation and Development

PM Market production

PNM Non-market production

POC Official Plan of Accounting Standards

PT – ACS Portugal Telecom – Healthcare Association

RHA Regional Health Authority

SAMS Union of Bank Employees of North, Centre and South Regions and the Islands Medical Assistance Services

SHA System of Health Accounts

SINUS Portuguese Information System for Healthcare Units

SNA System of National Accounts (United Nations)

SONHO Portuguese Hospital Patient Management System

Vm Market sales

Vnm Non-market sales



IINNTTRROODDUUCCTTIIOONN

This document forms part of one of the implementation phases of the pilot Health

Satellite Accounts project and its aim is to describe in detail the methodological work

employed during the different stages involved in constructing the system. In other

words, it provides an introduction to the guiding methodological principles behind the

implementation of the Health Satellite Account in Portugal.

Chapter I presents the essential principles underlying its development, the objectives it

aims to achieve and the bodies that have contributed to its preparation and

production.

Chapter II contains a detailed explanation of the methodology used in each of the

phases of the work, which consisted in establishing an inventory and classification

system for the universe, the compilation of data, the consolidation of results and the

completion of Tables 2 to 5, as envisaged in the OECD SHA manual.

In the conclusion of the methodological description the limitations encountered in the

process of compilation are described as awell as the main methodological and

conceptual differences between national accounts and the Health Satellite Accounts

that result in differences in the figures are detailed.



CCHHAAPPTTEERR II –– OOVVEERRVVIIEEWW

The debate on the issue of health has been growing over the last few decades.

Studies of the organisational models used in different health systems and analyses of

their activities, based on criteria of sustainability, efficiency and equity, are being used

today as indicators of the degree of a country’s development, as they directly affect

the population’s well-being and quality of life.

Government health policies have resulted in changes in the way national health

systems are organised and operated, and they therefore require automatic changes in

the behaviour of those involved, in both the public and private sectors. The

implementation of a system of accounts considering the specificity of health care is

justified, all in all, by the need to keep up with developments in the sector, such as the

effects of sectoral policies on the organisation and activities of all involved in both the

public and private sectors, from the point of view of providers of both health care and

funding.

1. OBJECTIVES

The main aim of the Satellite Health Accounts is to evaluate the resources available in

a country for use in the provision of healthcare services. In general, it measures total

expenditure on health care, including the different components making up a national

health system, i.e. healthcare providers, financing agents and healthcare functions.

The driving force behind the development of the Health Satellite Accounts in Portugal

was the need:

To provide statistical information to meet OECD requirements

Until now, information on the health sector in Portugal has been provided in the

National Accounts. However, due to differences in concepts, methods and

classifications, it was considered insufficient, as it did not go into enough detail



regarding the variables required to meet OECD requirements. As a result, there was

an urgent need to set up an accounting system to provide information that satisfied

these requirements.

The need for updating and maintenance of the System of Health Accounts was

reinforced by recent developments at international level, the setting up of the joint

questionnaire “SHA Data Collection” involving OECD, EUROSTAT and WHO.

The main purposes of the joint questionnaire are:

- At national level: to reduce the burden in the data collection for the national

agencies.

- Internationally: to harmonize principles, concepts, methodologies as well as to

improve the availability and comparability of the health expenditure.

To use it as a tool in evaluating, analysing and deciding on health sector policies

The recent restructuring of the health sector, with fundamental changes in the National

Health Service (NHS), generated a demand for information for use in analysing and

assessing the sector and providing tools for analysing, monitoring and supporting

political decisions. In view of the need for detailed information giving a more

exhaustive picture of the health sector than the one currently available, the project

was supported by the government agencies and was given a degree of priority in the

production of health sector statistics.

2. BODIES INVOLVED

A working group of representatives of different government institutions has been set

up to implement the pilot project Health Satellite Accounts and achieve the established

goals. The bodies involved are the body responsible for financial management of NHS

(IGIF- Health Financial and Computer Management Agency), the Directorate-General

of Health (DGS), the National Statistical Institute (INE) and the Directorate-General of

Studies and Forecasts of the Ministry of Finance and Public Administration (DGEP)..



CCHHAAPPTTEERR IIII –– MMEETTHHOODDOOLLOOGGYY

In Portugal the implementation of the Health Satellite Accounts is based on the

principles, concepts, definitions and classifications contained in the OECD “System of

Health Accounts version 1.0” (SHA) manual which, in turn, is based on the United

Nations System of National Accounts (SNA-93) and its European version, the

European Accounts System 1995 (ESA1995), whose implementation is compulsory by

EU Regulation..

During the planning stage of the project, the year 2000 was established as the

benchmark year and the first year for which the account would be compiled and the

following tables have been produced (in Annexes 1 to 4), as envisaged in the SHA

manual:

Table 2: Current expenditure on health by function of care and provider

industry

Table 3: Current expenditure on health by provider industry and source of

funding

Table 4: Current expenditure on health by function of care and source of

funding

Table 5: Total expenditure on health, including health-related functions

The task of creating the Health Satellite Accounts system was organised into the

following different phases:

1. The set-up of the Health Satellite Accounts universe;

2. A three-dimensional classification of the units in the universe;

3. The compilation of data;

4. The conciliation of results and compilation of SHA Tables 2, 3, 4 and 5.

The first phase of the work consisted of defining the statistical units that comprised the

universe of the Health Satellite Accounts system. In organising the available

information, obtained from different sources, it was necessary to avoid duplicating the



reporting of units. The units were classified according to the SHA manual

classifications by providers of healthcare, financing agents and healthcare functions,

(in Annexes 5 to 7). At the end of these two phases, which provided an inventory and

a three-dimensional classification of the universe, a general file was produced

containing all the units in the inventory and providing details of the following:

Institutional sector – code and description;

Identification as financing agent, provider or both;

ICHA Classification – HF, HC, HP;

Identification of CAE;

Identification of main organisation holding the relevant information.

This was followed by the compilation of data, during which estimates were made of

spending on health care by provider and by financer and the structure of healthcare

functions were defined, making use of different sources of information.

The tasks of consolidating the results and compiling Tables 2, 3, 4 and 5 were

included in one single phase of work because they so closely relied on each other.

After consulting all the information on production and financing estimates available

from the different sources, efforts were made to establish median levels of

expenditure, production and financing and, subsequently, to allocate these by type of

healthcare function. The final results were used to complete SHA Tables 2, 3, 4 and 5.

Each of these phases of work will be described in detail, in particular the methods and

sources of information underpinning their development. To conclude this

methodological approach, it was considered essential to include in this chapter an

explanation of the main conceptual boundaries and differences between national

accounts and the Health Satellite Accounts.



1. THE INVENTORY OF THE HEALTH SATELLITE ACCOUNT

UNIVERSE

The aim of producing an inventory of the Health Satellite Accounts universe was to

organise a database containing the statistical units that were to be observed. In order

to make the universe as complete as possible, the following different sources of

information were used:

The INE Ficheiro de Unidades Estatísticas (FUE – Central Register of Statistical

Units)

INE has its own database, the FUE, in which statistical units (corporations and similar,

non-profit organisations and general government units) active in mainland Portugal

and the Autonomous Regions of the Azores and Madeira are recorded. The FUE

classifies statistical units according to the following variables: identification of units

(corporate tax number (NPC), business name, address and post code), stratification

(main activity according to the CAE-Rev. 2.1, secondary activity according to the CAE-

Rev. 2.1, number of employees, turnover, the auxiliary variable of location of head

office (DT/CC/FG), legal form, institutional sector, number of local units, nomenclature

of statistical territorial units (NUTS) and characteristics and demography (telephone, fax,

e-mail, international trade, share capital, % foreign capital, % state capital, % private

capital, business, address, date founded, starting date of activity, the Madeira tax free

zone, legal status grouping).

The statistical units that comprise the universe of the Health Satellite Accounts were

selected primarily by using the CAE-Rev. 2.1 criterion of main economic activity, which

is the national version of the NACE. However it was necessary to include the

statistical units that provide health care as secondary activity or activities related to

health in order to guarantee the exhaustiveness of the Satellite Accounts,

The following CAE-Rev. 2.1 classifications were considered:



Code Description

Section G – Wholesale and retail trade; repair of m otor vehicles, motorcycles

and personal and household goods

52310 Retail sale of pharmaceutical goods (dispensing chemists)

52320 Retail sale of medical and orthopaedic goods

52482 Retail sale of optical, photographic and cinematographic

goods and precision instruments

Section J – Financial intermediation

66011 Life insurance

66012 Other activities complementary to social security

66030 Non-life insurance

67200 Activities auxiliary to insurance and pension funding

Section K – Real estate, rental and business activi ties

73100 Research and development on physical and natural

sciences

Section L – Public administration, defence and comp ulsory social security

75111 Central Administration

75112 Regional Administration

75113 Local Administration

75121 Public Administration – healthcare activities

75130 Public Administration – economic activities

75210 Foreign Affairs

75220 Defence activities

75230 Justice

75240 Public security, law and order

75300 Compulsory social security activities

Section M – Education

80300 Higher Education

80421 Professional training

Section N – Health and social work

85110 In-patient healthcare activities



85120 Outpatient medical practice activities

85130 Dental practice activities

85141 Diagnostic laboratories

85142 Ambulance activities

85143 Nursing activities

85141 Blood and organ banks

85145 Other human health activities, n.e.c.

85312 Social work activities for the handicapped, with

accommodation

85313 Social work activities for the elderly, with accommodation

85314 Social work activities, with accommodation

85322 Social work activities for the handicapped, without

accommodation

85323 Social work activities for the elderly, without

accommodation

85324 Social work activities, without accommodation

Section O – Other community, social and personal se rvice activities

91200 Activities of trade unions

91331 Cultural and recreation association activities

91333 Other association activities, ne

The Health Satellite Accounts universe was also completed by including other units,

namely units whose main activity does not involve the provision of health care but

includes small units that provide healthcare services for employees and their

households.

The IGIF provided lists of bodies financing NHS institutions, taken from the

Sistema de Gestão de Doentes Hospitalares (SONHO- the Portuguese Hospital

Patient Management System) and the Sistema de Informação para as Unidades

de Saúde (SINUS – the Portuguese Information System for Healthcare Units) and

from non-profit institutions serving households (NPISHs) financed.



Through the DGS it was possible to access lists of all the entities that operated

under agreements with the NHS, including private social solidarity institutions

(IPSS) and other private in-patient or out-patient establishments and licensed

healthcare establishments with or without agreements with the NHS.

According to the definition contained in the DGS publication “Informação geral -

elementos estatísticos Saúde / 2000” ("General Information – Health Statistics /

2000"), the entities operating under agreements/conventions consisted of private

healthcare providers who had signed agreement contracts with the Ministry of

Health or Regional Health Government (RHAs) with the aim of providing health

care jointly with the NHS as part of the national network of healthcare providers.

The INE has full lists covering the general government universe, broken down into

its respective sub-sectors of Central, Regional and Local Government.

The Comissão Nacional de Luta contra a Sida (CNLSida – the National Committee

for the Fight Against AIDS) provided a list of the institutions that were financed.

The definition of the Health Satellite Accounts universe was therefore the result of a

combination of these lists of units or, in other words, the collation of these sources of

information, using the CAE, the institutional sector classification, and the NPC in order

to prevent duplicating reporting of the units, with the aim of creating a full inventory.

During the initial phase of the work it was not possible to collate the information from

the DGS with that of the FUE due to the fact that units were not identified by NPC

within the DGS. This difficulty was, however, overcome as the work progressed.

The universe of SHA is updated every year with the integration of units that start their

activity in each year, the removal of units that cease activity, the update of the

classification of the activity code as main, secondary and related, the change in the

institutional sector classification and eventual changes in Tax Number.



2. THE THREE-DIMENSIONAL CLASSIFICATION OF THE HEALTH

SATELLITE ACCOUNTS UNIVERSE

The OECD SHA manual recommends classifying units in accordance with the

classification proposed in the International Classification for Health Accounts (ICHA)

(Annexes 5 to 7).

The ICHA envisages a three-dimensional approach to establish:

Healthcare service provider industries (ICHA-HP);

Financing Agents of healthcare (ICHA-HF);

Healthcare by function (ICHA-HC).

This three-dimensional classification is justified by the complexity of national health

systems and by the need to classify the different elements they encompass.

According to the SHA manual (§ 1.6): The provision of health care and its funding is a

complex multi-dimensional process. The set of tables in the SHA addresses three

basic questions:

Where does the money come from? (financing agents)

Where does the money go? (providers of services and goods)

What kinds of services are performed and what types of goods are

purchased? (functions of health care)

The classification of the units in the Health Satellite Accounts universe is based on the

principles and guidelines contained in the OECD SHA manual.



2.1- Classification of units by healthcare provider (ICHA-HP)

In accordance with the system used in the OECD SHA manual for classifying units in

the Health Satellite Accounts universe by healthcare provider (ICHA-HP), the following

principles have been taken into consideration:

The basic criteria for classifying healthcare providers by industry (ICHA-HP) will be

the main activity of the establishments (§ 4.3).

The ICHA-HP provider classification comprises both producers of health care as

main activity (for example, hospitals and doctors' offices) and also those that

provide healthcare as a secondary activity. Secondary producers provide

healthcare services in addition to their main activity, as a secondary activity.

Examples are residential care units which provide mainly social services, such as

asylums, in combination with healthcare services such as long-term nursing care

or psychiatric care (§ 4.5).

Producers of intermediate products used in health care are not considered ICHA-

HP providers of health care (§ 4.6). Similarly, services intended for the

intermediate consumption of the providers should be excluded. In particular, the

production of self-employed healthcare providers offering services in a hospital

must be excluded, since this constitutes an intermediate form of production that

has already been accounted for in the production of the hospital itself. The

justification for this procedure is based on the fact that the intention is to calculate

the production intended for final use.

The methodology for classifying the units in the universe by healthcare provider was

based on attributing a healthcare provider code (ICHA-HP) to the main activity to each

unit classified with a code according to the CAE-Rev. 2.1.

According to the CAE-Rev. 2.1 classification of principal activity, the following

attribution criteria were considered:



CAE

Code

CAE

Description

ICHA – HP

Classification Classification criteria

52310

Retail sale of pharmaceutical products (Dispensing chemists)

HP. 4.1 – Dispensing chemists

Attributed to all units.

52320

Retail sale of medical and orthopaedic goods

HP4.3 – Retail sale and other suppliers of hearing aids; HP.4.4 – Retail sale and other suppliers of medical appliances (other than optical products and hearing aids)

Hearing aids – HP 4.3; Other – HP 4.4.

52482

Retail sale of optical, photographic and cinematographic equipment and precision instruments

HP.4.2 – Retail sale and other suppliers of optical glasses and other vision products

Optical equipment – HP 4.2.

85110

In-patient healthcare activities

HP.1.1 – General hospitals; HP.1.2 – Mental health and substance abuse hospitals; HP. 1.3 – Speciality hospitals; HP.2.1 – Nursing care facilities; HP.3.1 – Offices of physicians; HP.3.4.3 – Ambulatory care centres; HP.3.4.2 – Out-patient mental health (psychiatric) and substance abuse

Hospitals – HP.1.1, 1.2 or 1.3, according to specialisation; Health Centres – HP 3.4.9; Convalescent homes and rest homes – HP 2.1; Clinics – HP 3.4.5; Consultancies / General and specialist medical centres – HP 3.1; Alcoholism and drug addiction treatment centres and mental health centres (other than hospitals) – HP 3.4.2 (All treatment centres for alcoholics, drug addicts and mental health patients not classified under HP.1.2, assuming they provide specialist medical practitioners and mainly out-patient treatment);



centres; HP.3.4.9 – All other out-patient community and other integrated care centres; HP. 3.5 – Medical and diagnostic laboratories

Surgical centres (neurosurgery, aesthetic, ocular, vascular surgery) - HP 3.4.3; Medical-surgical centres – HP 3.1; Diagnostic centres providing Mariology, radiology and clinical analysis - HP 3.5; All units registered under the name of the owner or medical societies with no specified stated business are assumed to be consultancies – HP 3.1; All centres / consultancies offering the following specialist services are considered HP 3.1: Physiotherapy (medical), ophthalmology, orthopaedics, radiotherapy, gynaecology and obstetrics, traumatology, gastroenterology, angiology, respiratory diseases and allergies, rheumatology, physiatrics, dermatology, endocrinology, urology, oncology, phlebology, neurology, otorhinolaryngology, etc.

85120

Out-patient medical practice activities

HP.3.1 – Offices of physicians; HP.3.2 – Offices of dentists; HP.3.4.2 – Out-patient mental health (psychiatric) and substance abuse centres; HP.3.4.3 – Free-standing ambulatory surgery centres; HP.3.4.5 – All other out-patient multi-speciality and co-operative service centres; HP.3.4.9 –All other out-patient community and other integrated care centres;

All units registered under the name of the owner or medical societies with no specified stated business are assumed to be consultancies– HP 3.1; Clinics, clinical centres and polyclinics, medical clinics– HP 3.4.5; Consultancies / offices of physicians – HP 3.1; Dental clinics – HP 3.2 (This code is only attributed to those solely involved with dentistry; if providing odontology and stomatology use 3.4.5) Occupational health care (companies with the designation Health, Safety and Hygiene at Work) – HP 7.1 Anaesthetic centres – HP.3.4.5; Psychology units – not a medical specialisation and as such should not be classified under HP.3.1 – HP 3.4.5;



P. 3.5 – Medical and diagnostic laboratories; HP.7.1 – Establishments as providers of occupational healthcare services

Sports medicine – HP 3.1; Reproductive medicine – HP 3.1; Nuclear medicine – HP 3.1 Psychotherapy, psychological diagnosis, psychoanalysis – HP 3.4.2; Psychosomatic medicine – HP 3.4.5; Aesthetic and plastic surgery centres – HP 3.4.3; Radiology, radiologists – HP 3.5 (as it is assumed that this is a diagnostic activity); Aesthetic medicine – HP 3.4.5; Weight control centres – HP 3.4.5; Forensic medicine offices – HP 3.4.5; Night-time medical assistence – HP 3.1 (if consultancies) Affective therapy – HP 3.4.5

85130

Medical dentistry and odontology activities

HP.3.2 – Offices of dentists; HP.3.1 – Offices of physicians.

Medical dentistry – HP 3.2; Odontology – HP 3.1; When it is impossible to separate the two activities, they should be classified under HP 3.2

85141

Diagnostic laboratories

HP3.5 – Medical and diagnostic laboratories

Attributed to all units

85142

Ambulance activities

HP.3.9.1 – Ambulance services


85143

Nursing activities

HP.3.3 – Offices of other health practitioners; HP.3.6 – Home healthcare services

Nursing centres – HP 3.3 Domiciliary nursing care – HP 3.6



85144

Blood and organ donor stations

HP.3.9.2 – Blood and organ banks


85145

Other human healthcare activities, n.e.c.

HP.3.1 – Offices of physicians; HP.3.3 – Offices of other health practitioners; HP.3.4.5 – All other out-patient multi-speciality and co-operative service centres; HP3.5 – Medical and diagnostic laboratories

When only identified by name of owner – HP 3.3; Clinics / physical medicine, rehabilitation, physiatrics centres – HP 3.4.5; Diagnostic centres – HP 3.5; Massage, physiotherapy and physical rehabilitation centres – HP 3.3; Paediatric centres – HP 3.1; Ophthalmology centres– HP 3.1

85312

Residential social work activities for the handicapped

HP.2.1 – Nursing care facilities; HP.2.2 – Residential mental retardation, mental health and substance abuse facilities; HP.2.9 – All other residential care facilities, n.e.c.

Residential social work activities – residential care/aid– HP 2 Physically handicapped: HP 2.9; Mentally handicapped: HP 2.2

85312

Residential social work activities for the elderly

HP 2.3 – Community care facilities for the elderly


85313

Residential social work, n.e.c.

HP.2.2 – Residential mental retardation, mental health and substance abuse facilities

Alcoholics and drug addicts – HP 2.2

85322

Non-residential social work activities for the handicapped





85323

Non-residential social work activities for the elderly

HP.2.9 – All other residential care facilities, n.e.c.


85324

Non-residential social work, n.e.c.


Alcoholics and drug addicts – HP 2.2

Notes on the classification of service providers:

CAE 52320 covers the retail sale of medical and orthopaedic goods, namely

artificial limbs and vehicles for the disabled. The SHA provider nomenclature

distinguishes between suppliers of hearing aids and suppliers of other medical

equipment. In certain situations it was not possible to distinguish between the two

different types of suppliers, since both products could be supplied by the same

unit. When it was not possible to distinguish between them, it was decided to

classify them all under HP4.2 - HP4.9;

The retail sale of optical glasses and other vision products is undertaken by the

units whose main activity is classified under CAE 52482, which also includes

suppliers of photographic and cinematographic equipment and precision

instruments. When a unit was not described as an “oculist”, as was the case with

many privately owned companies, there were additional difficulties with

classification;

It was assumed that, in addition to offering in-patient care, the principal activity of

clinics classified as in-patient (CAE 85110) was the provision of out-patient

services classified under HP.3.4.5.;

In dealing with the units registered under the name of the owner or medical

associations where no function was specified, which were classified under CAE

85110 and 85120, it was assumed that these were private medical offices and they

were therefore classified under HP.3.1;



CAE 85130 includes medical dentistry and odontology activities. The SHA

nomenclature recommends distinguishing between the practice of medical

dentistry and odontology, which at times proved impossible considering the way in

which production is organised in these types of units. In Portugal, the majority of

private offices which include dentists also frequently include specialists in

stomatology, maxilo-facial surgery, medical dentists and odontologists. In practice,

it became almost impossible to identify which of these specialists operated within

any particular unit.

2.2- Classification of financing agents of healthca re (ICHA-HF)

The OECD SHA manual establishes the criteria for classifying units in the Health

Satellite Accounts System by financing agent (ICHA-HF) as follows:

The financing classification of the ICHA establishes a total separation between

spending on health care by public and private financing units. This classification is

derived from the central SNA framework for institutional sectors of the economy (§

6.7).

The methodology for classifying the units which finance the healthcare system takes

into account the divisions between the institutional sectors established by the SNA

(Annexe 8) using the ICHA-HF nomenclature proposed in the SHA.

The criteria used to classify the units included in each level of the ICHA-HF

nomenclature are as follows:

HF.1 – General Government

General government units which finance the healthcare system comprise all units

which finance expenditure on healthcare, i.e. bodies which finance healthcare services

either as providers (production) or through transfers (financers). Item HF.1 covers the

following categories:



HF.1.1 – General government excluding social security funds;

HF.1.1.1 – NHS;

HF.1.1.2 – Public health sub-systems;

HF.1.1.3 – Other government bodies.

HF.1.2 – Social security funds

Identifying the entities classified under HF.1 involved an analysis of the following types

of expenditure, categorised according to the nature of the expenditure using a

correspondence table between the items of the Reports and financial statements of

the general government sector units and ESA95 transactions for purposes of National

Accounts:

- Purchase of goods and services – life insurance and other funding except

social security funds that are compulsory;

- Purchase of goods and services – pension funding and supplementary

occupational schemes;

- Purchase of goods and services – Non-life insurance;

- Purchase of goods and services – Human health services;

- Social benefits, except social transfers in kind – Work-related accidents;

- Social benefits, except social transfers in kind – Other social benefits;

- Social transfers in kind – Healthcare expenses;

- Social transfers in kind – Other transfers in kind;

After these operations had been selected, the units were analysed in relation to

alternative sources of information such as Ministry of Health reports, monetary

accounts and sources.



Notes on the classification of financing units within level HF.1.1:

HF.1.1.1 – NHS: includes a wide range of institutions dependent on the Ministry of

Health in its dual role of provider and financer of the healthcare services it produces,

whilst also funding the production of other providers through contracts and

agreements.

HF.1.1.2 – Public social insurance subsystems in health: managed by government

bodies which bear the healthcare expenses of restricted population groups, normally

their own employees. There are two kinds of public social insurance subsystems:

- Public social insurance subsystems in health which only finance expenditure on

health care, bearing part of the cost of healthcare services in accordance with

particular schemes and systems. They make use of a network of healthcare providers

with whom they have established agreements and conventions. They are financed

mainly by state transfers and contributions from participating organisations and also,

partly, by contributions from beneficiaries;

- Public social insurance subsystems in health which fund and provide healthcare

services, acting as the financers of healthcare services in accordance with particular

schemes and systems and also as provider units. Their funding consists of

expenditure on healthcare services provided either by the units themselves or by

private units with whom they may or may not have agreements and conventions.

Access is restricted to beneficiaries, although in some cases other users may take

advantage of the services on condition that they pay the full cost. They are normally

financed by the employers of the beneficiaries and also partly by contributions from

the latter.

HF.1.1.3 – Other government institutions: includes all other government institutions

which finance healthcare expenditure and other producers and financers of

government healthcare services which are not part of the NHS and public subsystems

of social insurance in health. The negative tax (-D51) corresponding to the income tax



deductions of health expenditure that is legally allowed to deduct by tax payers are

recorded under this category of financing agent.

HF.2 – The private sector

The private entities which finance the healthcare system were classified according to

SHA nomenclature and, in general terms, consist of the following:

HF.2.1 – Private social insurance subsystems – Private health subsystems

HF.2.2 – Private insurance enterprises (other than social insurance)

HF.2.3 – Private household out-of-pocket expenditure

HF.2.4 – NPISH (other than private social insurance)

HF.2.5 – Corporations (other than health insurance)

Notes on the classification of financing units within level HF.2:

HF. 2.1 – Private health subsystems: are managed by private entities which support

the healthcare expenditure of a restricted group of people, generally their employees.

They are usually financed by the employer and, to a lesser extent, the employees,

although the latter may not pay any contributions to the system, or are partly

responsible for healthcare expenditure in accordance with the particular regulations

established for these kinds of schemes. Their funding consists of expenditure on

healthcare services provided either by the units themselves or by private units with

whom they may or may not have agreements and conventions. The existing

subsystems which finance and provide health care offer their beneficiaries exclusive

access to the services of the providers and also offer access to other clients if they

pay the full cost of the service.

HF.2.2 – Private insurance enterprises (other than social insurance): a group of

insurance companies who offer health insurance policies and cover expenditure on

health care for the beneficiaries of health insurance policies, whether these are held

collectively by an employer for the benefit of their employees or are held individually.



HF.2.3 – Private household out-of-pocket expenditur e: the universe containing all

resident households who bear the cost of healthcare services directly without

reimbursement from any social insurance scheme.

HF.2.4 – NPISHs: all NPISHs which finance their healthcare industry.

HF.2.5 – Corporations (other than health insurance) : covers the group of

companies who finance their employees' health care or who finance the production of

small healthcare units for their own use with cost-free restricted access.

HF.3 – Rest of the world

Any funding of the National Health System by foreign entities (the rest of the world)

was not included. The SHA (§ 5.3) does not include the export of healthcare services

provided by domestic providers to foreigners but includes imports of healthcare

services. Conceptually, it is considered that funding supplied by the rest of the world

only occurs through the export of services and that payment for health care supplied

by national providers to foreign patients is outside the scope of the SHA.

2.3- The functional classification of health care ( ICHA-HC)

The functional classification of health care supplied by each provider unit conforms to

the guidelines contained in the SHA manual, taking the following into account:

The items in the functional classification refer to products/services and therefore to

the functional structure of output of the healthcare system. This should not be

confused with functions reported in the cost structure of providers or in the input

structure of services (means of production) involved in medical treatment

complexes (§ 3.25).



The statistical unit in functional distribution within the SHA is the specific,

functionally defined output of healthcare industries for final use (§ 3.26).

If a medical procedure involves different functions, the function representing the

main purpose of the procedure will be classified. The other functions involved in

the procedure will not be classified individually, since they will be considered inputs

(means of production), not final products. For example, any pharmaceuticals

consumed during the course of a treatment such as surgery, are considered inputs

(means of production) to the service "surgery" and should be classified under the

appropriate heading and not under ICHA-HC.5.1 “Pharmaceuticals and other non-

medical durables”.

In the initial phase, a very general functional classification was produced, represented

by the first digit of the nomenclature. Later, as the project developed, the functional

classification resulted from the direct attribution and application of structures dividing

the total estimated expenditure amounts by service provider whenever it was not

possible to categorise them directly. The methodology behind the division of

healthcare expenditure by service provider type will be discussed in the section

describing the compilation of data.



3. COMPILATION OF DATA

3.1 - Basic concepts

The task of compiling the data was based on the fundamental SHA definition (Chapter

5) for measuring healthcare expenditure and estimating national totals:

Total expenditure on health: measures the final use of resident units of healthcare

goods and services + gross capital formation in healthcare provider industries

(institutions where health care is the predominant activity).

As stated in §5.2 of the SHA manual, the abovementioned definition means that "total

expenditure on health care measures the economic resources spent by a country on

the functions HC.1 to HC.7 on healthcare services and goods, including administration

and insurance plus gross capital formation...". It thus measures the economic

resources available for a country to use on the functions of healthcare goods and

services.

Consequently the methodology used in compiling the data is based on establishing:

Expenditure on healthcare goods and services

(=)

Goods and services produced for health (available for final use)

It is important to distinguish between:

- Current expenditure on health – which is included in the concept of total

gross domestic expenditure. This does not include the export of healthcare

services (provided by domestic providers to foreigners) but does include

imports (expenditure on health care abroad by tourists and others (§5.3));

- Gross capital formation in healthcare industries (which adds to the stock of

resources of the healthcare system and lasts for more than a standard



accounting period). May be classified further by type of institutional unit

involved in the production of health services (§5.2).

Functional boundaries of total expenditure on health:

HC1 to HC4 – Personal healthcare services

(+)

HC5 – Medical goods dispensed to out-patients

(=)

Total personal expenditure on health (TPHE)

Total personal expenditure on health (TPHE)

(+)

HC6 – Prevention and public health services

(+)

HC7 – Health administration and health insurance

(=)

Total current expenditure on health (TCHE) (sum of HC1 to HC7)

Total current expenditure on health (TCHE) (sum of HC1 to HC7)

(+)

HCR1 – Gross capital formation in healthcare industries

(=)

Total expenditure of health (DTS = TPHE + TCHE)

The production boundary of healthcare services

The production boundary for healthcare services is similar to the one stipulated in the

SNA, with two exceptions:

Occupational health care should be recorded separately and included in the

national totals for healthcare spending. In the National Accounts system it is

normally considered an ancillary service and therefore is not usually accounted for



separately or, in other words, the expenditure is distributed across the primary and

secondary activities.

The sum which is recorded corresponds to the sum of the expenditure incurred by

corporations, general government and non-profit organisations in the provision of

occupational health care.

It includes:

- Surveillance of employee health – routine medical check-ups;

- Therapeutic care (including emergency healthcare services on or off business

premises).

It does not include remuneration in kind of health services and goods which do not

constitute intermediate consumption but rather actual final household consumption.

Expenditure on occupational health care may be approximately estimated as the

average cost of each type of medical treatment involved.

Transfers in cash paid to households for the household provision of care for sick or

infirm members of the family unit are considered household healthcare production,

measured by the value of the transfers. In national accounting practice, this

amount is considered only as a social transfer payment granted to households.

The own-account production of these personal services is not recorded in National

Accounts but must be recorded in the SHA, corresponding to social transfer

payments granted to households with the aim of compensating them for the

services they provide for the sick, infirm and elderly.

These payments are considered paid household "production". The element

corresponding to care given to family members should be recorded under final

consumption expenditure (final use) on health care and not under transfer

payments. The corresponding item should be shown separately in health accounts.



Health care as part of the informal sector

The production of healthcare services involving significant sums which aims to avoid

additional payments or evade taxes constitutes part of the informal economy and it is

therefore necessary to estimate and include this amount.

However, amounts corresponding to the illegal provision of healthcare services by

unlicensed professionals and the prescribing of drugs for illegal purposes (e.g. sport,

body building or drug addiction) should not be taken into consideration. Although they

are included in the SNA, they should be excluded from the SHA.

The treatment of subsidies and other transfers to provider industries

Payments to market producers by governments with the aim of influencing supply are

considered subsidies. However, this does not include payments by governments to

market producers which aim to offer total or partial financing of the purchase of goods

or services by households on the basis of risk or social need (such as health, for

example), whether within the social security system or outside it. These payments

must be classified as welfare benefits in kind (D.631).

General payments which governments make to non-market producer NPISHs are

usually categorised as transfers. However, they may assume the characteristics of

welfare benefits in kind (D.631) if they fulfil the requirements for this procedure, in

which case the NPI is probably producing market services.

The measurement of output: market and non-market production

The SHA (§5.21) recommends that the SNA principles for measuring the output of

healthcare services are followed. The SNA concepts of output and intermediate

consumption are applied analogously in calculating national expenditure on health in

the SHA. Expenditure on healthcare services provided by non-market producers to

households free of charge or at prices that cover only part of their production costs

may be underestimated in existing National Health Accounts. This separation of output

into market and non-market output is used in health accounting only as a technical

concept for valuing output of healthcare services correctly in monetary terms. It is not



shown as a separate item in the standard tables proposed for the SHA. For the

internal estimation process, separate accounts for non-market and for market

production will be an essential tool.

Time of recording and the accrual principal

Cash accounting, which is still applied in health accounts in some countries, records

only cash payments and records them at the time that these payments occur. It is now

widely recognised that recording on a cash basis can lead to a distorted picture (…)

(§5.35). The SHA recommends for these reasons that monetary flows should be

recorded on an accrual basis according to the following SNA definition:

“Accrual accounting records flows at the time economic value is created, transformed,

exchanged, transferred or extinguished. This means that flows which imply a change

of ownership are entered when ownership passes, services are recorded when

provided, output at the same time that products are created and intermediate

consumption when materials and supplies are being used” (§5.36).

Gross capital formation in healthcare provider industries

For the recording of gross capital formation, the SHA (§5.36) recommends that the

retail sale of medical goods should be regarded as a support activity in health care

and will therefore not be counted under the total gross capital formation of healthcare

providers.

The fundamental definition (§5.37) is:

Total gross capital formation in healthcare industries = Sum of gross capital formation

in the institutional units listed under the ICHA-HP classification items HP.1 to HP.3,

HP.5 and HP.6, where health care is the predominant activity.



Health expenditure aggregates in the SHA (SNA termi nology)

Key: PNM = Non-market production; Vnm = Non-market sales

SNA 93 Code Description Details of specific components P.41 (+) P.42 (=) P.4 (+) D.31 (+) P.41* (+) P.41* (=) P.4* (+) P.51

=

P.31 do S.14 (+)

P.31 do S.15 (+)

P.31 do S.13

Actual final consumption expenditure on health by households and NPISH

- Final consumption expenditure by households (always individual) - Final consumption expenditure by NPISH (individual) and - Final consumption expenditure by general government Actual final consumption expenditure on health by general government Actual final consumption expenditure on health (= P.41 + P.42) Subsidies on products Occupational health care (= CI Producer Units) Cash transfers to needy households Adjusted total actual final consumption expenditure on health (= P.4 + D.31 +P.41*) Gross capital formation in healthcare industries

Family expenditure on healthcare goods and services = Out-of-pocket payments = D.63 (Social transfers in kind) = PNM net sales (D.632) + welfare benefits in kind (D.631) D.632 = PNM – VNM (out-of-pocket payments) D.631 = payments to reduce the cost of healthcare goods and services to households, either as part of the social security system or outside it = Collective consumption expenditure (P.32) = PNM for collective consumption = on collective services supplied simultaneously to all members of society, such as, for example, general health administration, maintenance of public health care, etc. = Government subsidies to healthcare providers in order to lower the price of output, excluding welfare benefits in kind. D.311 and D.312 – Subsidies on imports/ exports (not included in health care); Estimate of occupational health care supplied by providers and other industries = Payment for household production of health care (consisting of health care for the sick and infirm provided by family members) Investment expenditure by provider units

DTS Total expenditure on health care = (P.4* + P.51)



Healthcare expenditure by sources of funding

Basically, §6.8 of the SHA establishes that healthcare financing can be recorded

from two different perspectives:

In National Health Accounts, financing by direct payment (out-of-pocket or third-

party payment) is usually treated as a breakdown of expenditure on health into

the complex range of third-party-payment arrangements plus direct payments by

households and other direct funding;

Financing considered as the balance of own resources used by each sector to

finance health care – in this kind of analysis the financing sources of the

intermediary financing agents (social security, private social and other forms of

insurance, NPISHs) are traced back to their origins. In addition, transfers such as

inter-governmental transfers, tax deductions, subsidies to providers and financing

by the rest of the world are included to complete the picture.

SNA 93

Code Sources of funding

Public Funding S.1311 D.51 D.63 P.42

Central government Tax deductions for households

Social transfers in kind Actual collective consumption

S.1313 D.31 D.63 D.62 P.42

Regional and local government Subsidies to providers Social transfers in kind Other social benefits except social transfers in kind Actual collective consumption

S.1314 D.63 D.62

Social security funds Social transfers in kind Other social benefits except social transfers in kind



P.42

Actual collective consumption

Private funding S.125 D.62 D.75

Private social insurance Other social benefits except social transfers in kind Other transfers

S.125 D.72 P.41

Other private insurance enterprises Private insurance claims Private households out-of-pocket, net

S.14 P.41 D.51

Household private expenditure Private households out-of-pocket, net Tax deductions for households

S.11 P.41* D.623 D.75

Other corporations Occupational health care Unfunded social benefits Other transfers

S.15 D.63 D.62 D.75

NPISHs Social transfers in kind Other social benefits except social transfers in kind Miscellaneous transfers

S.2 – Rest of the world

Details of the components of the sources of funding are provided in annexe 11. The

perspective of direct financing was adopted when producing the Health Satellite

Accounts.



3.2 - Estimating healthcare expenditure by healthca re provider

The main methodological principle used in the Health Satellite Accounts was the

identification of the concept of production with expenditure on healthcare goods and

services.

In order to establish a method for estimating healthcare expenditure that was

suitable for each type of provider it was first considered necessary to classify the

units according to their institutional character, by type of provider / producer.

To define the provider / producer type and sector for private NPIs the criterion of

50% was used (Annex 12):

If more than 50% of production costs were covered by sales, the institutional unit

was considered a market producer and was classified in the non-financial and

financial corporations sectors;

If sales covered less than 50% of production costs, the institutional unit was

considered a non-market producer and was classified in the NPISHs sector.

The 50% criterion was used for most of the units in the universe to determine the

type of producer and to apply the respective algorithm. This criterion was applied to

all producers subjected to the market/non-market analysis, including public

producers and NPIs.

However, homogenous groups of provider units emerged whose specific activities

implied that their respective production had to be estimated using a different

methodology. This was the case, for example, with estimates for the production of

sole proprietors, self-employed workers and occupational healthcare establishments.

All the units within the universe of providers belonging to the government and the

NPIs were analysed individually according to their status as market or non-market

producers.



Households as providers of home health care to family members were included with

the boundaries of healthcare service production as established in the SHA manual.

In the case of Portugal, this production was included in the results of the Health

Satellite Accounts and it was evaluated by using the amounts of social transfers

granted by the Social Security to households with this purpose.

The provider / producer groups were subsequently identified and each one was

attributed an algorithm for the different estimated expenditure / production.

In general, the different sources of information provided the necessary data for

estimates of the production of healthcare providers to be made.

Algorithms for estimating expenditure / healthcare production

Market producers

Market production represents that which is sold or is destined to be sold on the

market (§3.17-EAS95), comprising (§3.18-EAS95):

- Products sold at economically significant prices;

- Products subject to direct trade;

- Products used for payment in kind;

- Products supplied by one local unit of economic activity to another within the same

institutional unit, to be used for intermediate or final consumption;

- Products added to supplement existing products or work in progress.

Market producers include providers organised into companies or the market

activities of NPIs.

In general, the production of market producers is measured by the sale of healthcare

goods and services using the algorithm for attributing sources presented in Annexe

13, namely:



Healthcare market production (PM) = ∑ Sales in Health = ∑ Provision of services in

Health

Given that:

Market sales = Sales of market production;

In accordance with the EAS95 agreement, market producers may not supply any

other non-market products.

Note that for certain provider groups:

Providers HP.4.2 to HP.4.9 (All other sales of medical goods):

The value of HP.4.2 to HP.4.9 production was the result of splitting the final

household consumption of items coded NPCN1 331 (Medical, surgical and

orthopaedic equipment and parts) and 334 (Optical, photographic and

cinematographic equipment), in accordance with the production structure supplied

by the Inquérito Anual à Produção Industrial (IAPI - Annual Survey on Industrial

Production) for these products.

Production = Part of the value of final household consumption of products NPCN

331 and NPCN 334 products = (%) IAPI Production structure NPCN 331 X Final

household consumption of NPCN 331 + (%) IAPI Production structure NPCN 334 X

Final household consumption of NPCN 334 + Government and NPISH social

benefits in kind paid for these products

Providers HP.4.1 (Dispensing chemists):

Production = Value of medicines sold by dispensing chemists (out-patient),

excluding hospital dispensing chemists, valued at acquisition prices.

1 National Accounts Product Nomenclature



Providers HP.6.4 Other private insurance: Only health policies were considered.

Insurance production (health) = Total premiums earned net of reinsurance (1) +

Income from investment of the provisions (2) – claims due, net of reinsurance (3) –

Changes in the other technical provisions – provisions with for with-profits insurance

– variation in provision for deviations in costs of claims

(1) Total premiums earned = Gross premiums issued – reinsurance premiums

issued +/- change in provisions for premiums not purchased +/- variation in

provisions for premiums not purchased, reinsurance

(2) Income from investment of the provisions = income from capital + income from

other investments + Income from investment of the provisions of reinsurance + other

technical provisions (excluding gains realised +unrealised capital gains)

(3) The cost of managing claims should be deducted, although this figure is not

available by insurance branch, only by total. Therefore it was assumed that the

proportion of the imputed cost in cost of managing claims, in the Health branch is the

same for the total insurance total branches. In average it corresponds to 4%. The

new accounting plan for the costs in the insurance companies is understudy and it

will be used as soon as it will be implemented.

Non-market producers

Non-market production (§3.17-EAS95) covers production which is supplied free of

charge or at prices which are not economically significant.

The non-market production of health care must be assessed by the total production

costs, i.e.:

Non-market production of health care (PNM) = Intermediate Consumption (P.2) +

Compensation of Employees (D.1) + Consumption of Fixed Capital (K.1) + Other

taxes on production (D.29) – Other production subsidies (D.39) – Non-health Sales



Given that:

Non-market sales (Vnm) = sales of non-market production or, in other words,

payments intended to partly finance the costs of non-market production. In

relation to health care, for example, health fees would be considered under this

category and tuition fees would be considered in relation to schools;

Secondary non-health market sales (Vm) should be excluded:

PNM = [D1 + P2 + K1 + D29 – D39] - Vm

Example: processing the income of a state hospital:

- health fees are considered non-market sales (Vnm);

- The potential income from a canteen is considered non-health market

sales (referring to a product that is classified under hospital activity

(Vm)).

Non-market producers may, however, supply market production and production

for their own final use as a secondary activity. This market production must be

determined by applying the 50% criteria to each product. However, for the

purposes of a healthcare account, it is only important to register health output,

including sales related to health care.

Providers organised as self-employed and own-accoun t workers

The production of healthcare providers organised as self-employed and own-

account workers was estimated on the basis of observations on income tax (IRS)

and the registration of individual business activity.

By analysing both the supply and demand for this work it was possible to estimate a

figure for the work representing “additional employment” and corresponding to self-

employed / own-account workers and undeclared work. “Additional employment”

includes employment identified through statements of income presented for tax

purposes and the informal labour, which could not be calculated due to tax evasion.

In order to calculate production, an average income was subsequently estimated

and “additional employment” was converted into volume of work.

Production = Volume of “additional work” X Average income



Occupational healthcare establishments

These include small medical units based within institutions, particularly private and

local government institutions and other public organisations and public social

insurance systems (GNR, PSP, etc.) which aim to provide healthcare services to

restricted groups, generally employees and their households. The Defence and

prison hospitals were excluded, since their production was estimated using the

algorithm for non-market units, and also the providers included in private social

insurance systems.

For this type of establishment, only physical data relating to the type of medical care

provided exist. Therefore, in order to provide output it was necessary to multiply the

number of medical cases, by type of medical care, by the estimated average unit

cost for a similar type of medical care, i.e.:

Production = average unit cost of production by type of medical care (X) number of

medical cases by type of medical care

For some medical procedures the average unit cost of production had been

estimated and made available by the IGIF, using estimates calculated on the basis

of average unit costs for the same types of procedures in similar healthcare

establishments. Where information was not available, Decree-Law nº 132/2003:

Regulamento das Tabelas de Preços das Instituições e Serviços Integrados no SNS

(Regulation for Prices for NHS Institutions and Services) was used.

Fire brigade activity within the context of health care

Within the context of health care, fire brigade activity mainly includes the transport of

patients in ambulances, rescue and first aid and some medical and nursing

procedures. Their output was estimated through the current transfers made by INEM

(The National Institute of Medical Emergency) to these units and also through the

eventual amounts paid by the National Health Service declared under subcontracts.

The transfers made by INEM are intended to be the full payment of the respective

service rendered by these units.



Estimating the production of the administration of private social insurance

subsystems (HP.6.4)

The Portugal Telecom – Associação de Cuidados de Saúde (PT–ACS– Healthcare

Association) and the Union of Bank Employees of North, Centre and South Regions

and the Islands – SAMS – Medical Social Assistance Services (SAMS-Serviços de

Assistência Médico-Social), both private social insurance subsystems in health, are

providers of healthcare services and simultaneously the administrators of the

subsystems they represent. It was therefore necessary to estimate the production

corresponding to administrative expenditure, known as administrative production.

In the case of the PT–ACS, the estimate for administrative production was derived

from the difference between the estimated total value of the services provided and

the value of welfare benefits in kind and the estimated production of healthcare

services, as determined by the market production algorithm.

In relation to the SAMS- Norte, Centro and Sul Regions and the Islands scheme

(sub-system intended for the workers of the banking system), the production of

administrative services was the result of the difference between the total value of the

funding of the different bodies in the form of provision of services, sales and

contributions and the value obtained from welfare benefits in kind and the estimated

production of healthcare services, which was determined by the non-market

production algorithm.

Estimating the production of Hospitals-Enterprise ( HP1.1)

In December 2002, the Portuguese Government changed the legal status of 31

public hospital of the NHS into corporations with limited liability, under the

restructuring plan of the Health sector in Portugal. Later on, the legal status was

changed to a new recently created for public units designated EPE (Entrepreneurial

Public Entity). Although these hospitals no longer are included in the Administrative

Public Sector, they are still part of the NHS.

Subsequently to the change of the legal status of the hospitals that were designated

as Hospitals-Enterprise, it was necessary to analyse each of these units that are

public producers in terms of its nature whether it is market or non-market. This is an



analysis that must be done to allocate the unit to an institutional sector in the

National Accounts. In terms of health Accounts this analysis is important in the

extent that will condition the evaluation of its output.

As a result of the analysis it was concluded that all the Hospitals-Enterprise are

market producers and therefore their output is measured by the sum of the sales of

services in health.

It is important to stress that there is no change in the composition of the universe of

providers along the series because, on one hand these units are still providers in

HP1 and, on the other, they are still part of the NHS. Nevertheless, since 2003, the

output of these hospitals is evaluated by the sales and not by its cost of production,

as it happened before.

Estimating the production of the households as prov iders of health home

care

Presently the only available data to estimate the output of the households as

providers of home care (personal care) consists in the amount of transfers granted

by the Social Security. These amounts are granted to households that take care of

their relatives that are sick, disabled, elderly people that are dependants and

handicapped people. The data that are considered as output are supplied directly by

the Ministry of Social Security. Nevertheless there is a part of the imputed output

that is not recorded in virtue of the eligibility criteria for granting these transfers

associated to what is conceptually proposed in SHA.

Main sources of information

The Structural Business Survey (SBS)

The SBS was one of the sources of information used to estimate the production of

market producers organised as corporations. In order to select the units surveyed by

the SBS included in the universe, this information was cross-checked with NPC

criteria.



According to methodology for the extrapolation of the SBS values used in the

National Accounts, the universe of the statistical units is stratified according to

criteria of sector (corporations and households) of National Accounts, number of

employees, business amount, geographic location and economic activity. When

crosschecking the units included in the universe of the National Accounts with the

units included in the sample of the SBS, for each stratus, extrapolation coefficients

are calculated in function of the number of employees. The extrapolated figures refer

to information collected in the common module of the survey. The estimation of the

output for those units result from the application of the algorithm applied during

appropriation of the sources (annex 7).

The application of a direct method of correspondence between the SHA universe,

classified according to the classification of providers, and the units collected in the

sample of the SBS and further appropriation of the extrapolated results of SBS, by

provider, show for the years under study, a great inconsistency and change in the

results for estimates of output by health care provider (initial extrapolated values X0X0X0X0

by health care provider). Although the estimates for total output are representative

for total national, at least for activities whose main activity is health services, that is,

CAE’s 851, there are big distortions at the level of representativeness by health care

provider.

In order to estimate the output in the Health Accounts it was necessary to carry out

additional work in the re-calculation of extrapolation coefficients (Coef nps 1) to

guarantee the maximum representativity, at the level of the classification by health

care provider. By keeping the stratification of the universe of the National Accounts

and the classification at the level of provider, new extrapolators (Coef nps 1) and

new extrapolated figures for output X1X1X1X1 were calculated, according to the following

formula:

Extrapolated figuresX1X1X1X1 = Initial extrapolated figures X0X0X0X0 X Coef nps 1 Coef nps 0



By applying this new method it was possible to obtain new estimates for the output

representative at the level of the classification of health care provider. However there

are still some limitations and a lot of improvement need to be done.

At inception the definition of the sample respects criteria at the level of the

representativeness of the several variables of stratus previously defined and not at

the level of the classification of health care provider. As a consequence it results

that, for each stratus, some providers are not represented in the sample of the SBS.

It was decided to correct the extrapolated figuresX1X1X1X1 for the producers recorded under

CAE 851 by assuming that the maximum limit for the estimate of the production that

should be considered, for each stratus, would be the estimated value resulting from

the initial extrapolated coefficient (Initial extrapolated figures X0X0X0X0). The difference

between the estimated production X0 X0 X0 X0 ---- X1X1X1X1, was directly imputed to the providers that

are not represented in the sample, based on the structure of the business amount.

It was considered as final estimated production, the extrapolated figures X1X1X1X1,,,, for the

producers classified in other CAE with a secondary activity in health care.

In this case no correction in order to include the providers that are not represented in

the sample of the SBS was made. This is to avoid the overestimation of the

production through the inclusion of the output of statistical units outside SHA.

This situation occurred every time that any unit that was representative in the SHA

universe, for each stratus, at the level of the classification of providers was not

inquired. The production of these units was not considered in the extrapolated

figures X1X1X1X1.

Generally, the above-mentioned problems are more frequent for the units of lesser

dimension and/or and providing health care as secondary activity. This is because,

for the enterprises of higher dimension (equal or greater than 100 workers) the

exhaustiveness is guaranteed in the survey.

The units surveyed, obtained in specific annexes, namely Annexe N – Health,

Annexe M – Education (Higher Education) and Annexe G – Commerce, were not

extrapolated but considered in the analysis of these units, namely to obtain the

structures of production, by functions of health care..



Survey typology:

Model A – Corporations with 20 workers or more. It is exhaustive for units with 100

workers or more.

Model B – Corporations with less 20 workers

Specific Education (Higher Education): Section M

Specific Healthcare Annex: Section N

Specific Commerce Annex: Section G

Characteristics:

- Collection method: Complete / Sample

- Information collected from: NUTS I (Mainland, Azores and Madeira)

- Frequency of collection and publication: Annual

- Units surveyed: Corporations

- Information collected by: Post

Annual financial statements

The information supplied by annual financial statements was analysed on an

individual basis for each unit and, depending on whether the producer type was

classified as market or non-market, the appropriate production algorithm was

applied. The annual financial statements supplied information on:

- private social insurance subsystems, in the case of the SAMS and the PT-ACS;

- public social insurance subsystems in health, such as ADSE;

- market productive units organised as corporations that provide healthcare

services as a secondary activity;

- non-market productive units in the government

Information supplied by the IGIF

The IGIF compiles the NHS Annual Accounts which contain information on all the

provider units within the NHS (e.g. profit and loss statements and their breakdown).

In addition, the existing IGIF database provides detailed information on the different

cost account items in the profit and loss statement for all NHS provider units such as



Regional Health Administrations (RHAs-managers and providers of health multi-

centres)), Hospitals (central, specialised, district level one and the Portuguese

Institute of Oncology), Psychiatric Services, Other Autonomous Services and

Educational Services. The available information enables data to be obtained by

function, since it includes highly detailed unitary data classified by medical

procedure.

Through the IGIF it is possible to obtain, for example, information on the average

unit cost of general out-patient care, specialist appointments (Gynaecology /

Obstetrics, Ophthalmology, Otorhinology, Paediatrics, Pneumology, Stomatology,

General and Family Medicine), Medical Analysis, Radiology / Imagiology and

Physical Medicine.

Estimates of average unit costs include expenditure on personnel, direct

consumables and other direct expenses resulting from an examination of internal

sources of information:

General out-patient care – Average overall cost in 38 district hospitals;

Specialist appointments (except family and general medicine) – Average costs of

(medium-sized) district hospitals where a cost centre exists;

General and Family Medicine appointments – Average cost of internal medicine

appointments in level-one hospitals (small district hospitals);

Analysis, Radiology and Physical Medicine – Average cost in (medium-sized) district

hospitals where a cost centre exists.

Information from income tax (IRS) and corporate tax (IRC) returns

Information originating from IRS and IRC sources is supplied anonymously and is

broken down into a five-digit code by Classification of Economic Activity (CAE). The

fact that units cannot be identified by NPC means that there are difficulties involved

in crosschecking the CAE and the provider code, as units may be wrongly classified

in terms of CAE but cannot be corrected. There may also be other problems, such

as the possibility of CAE codes corresponding to more than one provider code,

meaning that the respective provider code cannot be correctly attributed.

Nevertheless, taking these limitations into account, the sources were duly analysed.



In terms of the IRC, units were selected on the basis of the CAE codes considered in

the Health Satellite Accounts. In the case of the IRS, in addition to the CAE coding,

the IRS Classification of Economic Activity system (CIRS), which has been in force

since the year 2000, was also used (table taken from DL 442-A/88 (IRS ORIGINAL)

in Annexe 14). In both cases production was estimated by using the market

production algorithm applied to providers by nomenclature.

The rules for attributing ICHA-HP nomenclature to the production specified by the

CAE and CIRS codes are as follows:

CAE Rev. 2.1 code ICHA - HP

85110 HP.1.1; HP.1.2; HP.1.3; HP.2.1

85120 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.5; HP.3.4.9

85130 HP.3.2

85141 HP.3.5;

85142 HP.3.9.1;

85143 HP.3.3; HP.3.6;

85144 HP.3.9.2;

85145 HP.3.9.9; HP.3.6; HP.3.3

IRS code ICHA-HP

6.1 HP.3.3; HP.3.6

6.2 HP.3.3; HP.3.6

6.3 HP.3.3; HP.3.6

6.4 HP.3.3; HP.3.6

8.1 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.2 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.3 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.4 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.5 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.6 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.7 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9



8.8 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.9 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.10 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.11 HP.3.1; HP.3.4.3; HP.3.4.4; HP.3.4.9

8.12 HP.3.2

8.13 HP.3.2

Statistics on medicine products from the Instituto Nacional de Farmácia e

do Medicamento (INFARMED – National Pharmacy and Medicines Institu te)

INFARMED annually publishes data on the medicine products sector in Portugal,

relating to production, distribution, authorised sales, partnerships and the dispensing

of medicine products to out-patients within the NHS and other public social

insurance subsystems. To estimate the production of dispensing chemists classified

under HP.4.1, direct information on sales figures for (out-patient) chemist's items

was used.

Information on insurance statistics from the Instituto Seguros de Portugal

(ISP - Portuguese Insurance Institute)

The ISP, the official supervisory body for the insurance and pension funds business

sector, produces an annual report containing data on the insurance industry. Only

the health policy industry is relevant to the Health Satellite Accounts. The overall

health policy business activity can be extracted from the information published by

dividing the Sickness and Accidents accounts.

Annual survey of Mutual Aid Associations;

This was a survey of associations categorised as providing cash social benefits for

healthcare units, i.e. for preventative and curative medicine, rehabilitation and

medical products aid. The associations were classified by provider type and

production was estimated using the appropriate algorithm.

Characteristics:




- Frequency of publication: Annual

- Units surveyed: Associations


- Collection method: Complete

Survey of private social solidarity institutions (I PSSs);

This survey was the main source of information used in estimating the production of

the IPSSs.

The majority of IPSSs are involved in various activities, particularly in relation to the

provision of healthcare services and social work with households, the elderly,

invalids, the poor and excluded social groups such as delinquents and drug addicts.

Due to the specific nature of the work of these institutions, explained by their multiple

functions and main areas of interest, and bearing in mind the detailed information

available in the IPSS survey, it was necessary to adopt certain procedures to avoid

over-assessing their production. In practice, in all the phases involved in processing

the information contained in the survey, cross-references were made between the

functions and main areas of interest and the types of activity/providers, since these

functions and areas of interest represented the economic activities exercised by the

units. Thus, in the survey, for example, a unit with a hospital and an old people's

home corresponded to an illness with its respective main area (the hospital) and to

old age with a day centre as its main area, to Home care, etc. It was therefore

possible to classify different establishments (provider codes) on the basis of the

different functions and main area contained within each unit.

In the initial phase it was necessary to determine the common units in the universe

and survey and select the functions and main areas that could be evaluated in terms

of the Health Satellite Accounts, as follows:



Function Main area ICHA–HP

Illness In-patient hospital care

Hospital care

Out-patient care

Auxiliary means of diagnosis

Other

HP.1.1* / HP.2.3**

HP.1.1*

HP.1.1* / HP.3.4

HP.3.5

HP.5 / HP.3.9 / HP.2.3**

Old age Homes for the elderly

Residential homes for the elderly

Home care

Other

HP.2.3

HP.2.3

HP.2.3

HP.2.3

Disablement Home care

Residential homes

Rehabilitation centres for the blind

Other

HP.2.3

HP.2.2

HP.2.9

Other activities Dispensing chemists HP.1.1* / HP.4.1

* If hospital units with different functions

** In the case of healthcare establishments for the elderly involving in-patient hospital care, out-

patient care and others.

Although each institution was initially classified in general terms as a provider unit,

due to the specific nature of the activities involved it was decided to separate the

different main areas of each institution and individually re-classify them by provider

type.

Subsequently, the producer type was classified in detail by function and main area

and the appropriate production algorithm applied, depending on whether market or

non-market production was involved.

Some IPSSs involved in social work – with the elderly, in homes for the elderly and

residential homes – presented healthcare costs.

It could be seen that, in most cases, the healthcare costs for these institutions were

provided either to the NHS or to private sector providers, meaning that production

had already been accounted for. However, in cases where institutions possessed

healthcare units for the elderly there were problems in estimating expenditure, due



to a lack of detailed information that would enable a separation to be made between

social work expenditure and healthcare expenditure.

- Characteristics:

- Collection method: Complete


- Frequency of publication: Annual

- Units surveyed: Companies/Institutions


Inquérito Anual à Produção Industrial (IAPI – Annual Survey on Industrial

Production)

The IAPI provided detailed information of the annual output for products grouped

under the NPCN code:

331 – Medical, surgical and orthopaedic equipment and parts – all orthopaedic

categories were considered, with the exception of medical and surgical equipment;

334 – Optical, photographic and cinematographic equipment – all categories were

considered, except for sunglasses, binoculars and other optical microscopes, n.e.c.,

photographic equipment with reflex viewfinder using ≤35 mm film, slide projectors,

projector screens, parts and accessories for fixed projection equipment.

INE healthcare statistics

From the primary data for healthcare statistics it is possible to obtain quantitative

data pertaining to out-patient care, specialist and diagnostic procedures, dental

health care, therapy and nursing procedures carried out in medical units based in

different private and official institutions (military, paramilitary, prison, local authority

and other) which serves as a basis for estimating the production of occupational

healthcare establishments.

Report and Financial Statement of the Social Securi ty



The report and financial statement of the Social Security supply directly monetary

data concerning the social transfers granted to households that provide home care

to their relatives and family that require temporary health care or long-term care.

Decree Law nº 132/2003 - Regulations for Prices for NHS Institutions and

Services

Whenever it was impossible to obtain an estimate of the average unit costs of

medical procedures, the following codes from the Decree-Law nº 132/2003 were

consulted:

Electrocardiograms – Code 40301

Electro-encephalogram – Code 63011

Dental healthcare procedures – Extractions – Code 37505

Dental healthcare procedures – Fillings – Code 37010

Injections, average weighted – Code 99070+99080+99090

Dressings and other – Code 99150

Annexe 15 presents some of the algorithms used to calculate healthcare

expenditure and the respective sources of information, identified by code and

provider nomenclature.

3.3- Estimating healthcare expenditure by healthcar e financer

As previously stated, a group of entities exist which finance the healthcare system

and were classified according to the ICHA-HF nomenclature stipulated in the SHA.

In general, these financing bodies may be grouped into:

Financers of the healthcare system only;

Financers of the healthcare system and providers of health care.

With regard to units that only finance the healthcare system, the figures for the

financing of the production of the different providers are derived from the

appropriation of data supplied directly by the sources of information.



For those which are both financers and producers of healthcare services, calculating

the value of the funding includes:

An estimate of the funding of the production of a provider unit by the unit itself,

which corresponds to:

the final consumption expenditure of a non-market unit on the non-

market production of goods and services (in the case of NHS

healthcare services or, for example, the SAMS in its role as provider);

or

company expenditure on intermediate consumption on behalf of its

employees (occupational healthcare units); or

expenditure in the form of social transfers that do not constitute

provisions made by the units on behalf of their employees (medical

posts organised as non-autonomous schemes by units – e.g. military

hospitals);

The financing of production by other entities, corresponding to:

social benefits in kind, which are also partly included in the final

consumption expenditure of non-market units (such as NHS payments

to providers of private health care); and

social benefits from market producers (such as insurance payments to

hospitals);

The financing of production by households.

In situations in which the entities are healthcare providers and the sole financers of

their own production and are not supported by any other funding or financed by

other providers, it was assumed that the value of the financing was always equal to

the estimated value of the production.

In the particular case of financing through private household expenditure, when it

was impossible to obtain detailed figures from the sources of information the



balancing item or, in other words, the residual value, was considered the result of

the process of consolidation.

The financing provided by insurance companies in the form of health insurance

claims by functions of health care is only available at a reduced level of detail. An

analysis of the type of functions of health care usually covered by health insurance

policies was made. A direct allocation of the amounts of claims of health insurance

declared by health corporations was made with the available data and respective

breakdown.

Data on financing supplied by insurance corporations are available with the following

detail:

o Hospital expenditure;

o Expenditure on out-patient care;

o Medicine products;

o Dental care;

o Expenditure on childbirth services;

o Prosthetics/orthopaedic appliances;

o Others.

The income tax deductions were considered as financing of current expenditure in

health. However the Ministry of Finance only financed a total amount without any

detail that enable the direct allocation by type of provider or by function of health

care. Therefore it was necessary to use indirect methods of estimation to allocate

these expenditures by provider and by function of health care. It was considered that

that the structure of private expenditure of households was the most appropriate to

allocate these amounts, considering that this is actual expenditure made by tax

payers and reported in the tax statement.

Concerning the expenditure in health resulting from professional sickness and risk,

the Social Security also publishes, in its report and financial statement, the amounts



of financing by provider and functions of health care. In fact, Social Security is

responsible for this kind of expenditure.

In any of the situations described in Section 3.3, the same procedure was adopted

for analysing the different sources of information that provided data on financing:

Whenever the details of the information made it possible to attribute amounts of

financing by provider, in accordance with the provider nomenclature or, in other

words, to identify the provider entity intended to receive the financing;

Conversely, when information existed on the revenue of providers this was

attributed on the basis of the different sources of financing or, in other words, by

identifying the financing bodies funding a particular provider.

Main sources of information

Information from the IGIF

The main source of information for the figures for NHS financing, providing

information on the dual aspects of its role as financer and provider:

NHS financing by financing body:

Current revenue collected by health centres, hospitals (including psychiatric

hospitals) and other autonomous services from insurance companies, the

different clients of state institutions, other clients / parties liable for payment

and social insurance subsystems in health such as ADSE, the Military, para-

military personnel, SAMS, IOS-CTT, the social services and other

subsystems;

Other amounts received by different entities within the NHS via subsidies paid

by the IGIF and state entities and other entities, namely IPSSs.

NHS financing of other healthcare providers through expenditure on private

providers on the basis of contracts and agreements.

INFARMED statistics



INFARMED, as the regulatory body for the medicine products sector in Portugal,

provides information on the market structure of medicine products which enable

NHS, social insurance subsystems and healthcare user costs to be calculated.

However, it is not possible to determine the amounts paid by insurance companies

in relation to health insurance on the basis of the INFARMED information as there

are not normally any agreements between insurance companies and dispensing

chemists. In practice, this amount is included in the component corresponding to

costs borne by households.

Ministry of Defence statistical yearbook

In its statistical yearbook the Ministry of Defence publishes various types of

information on defence. In particular it provides statistical data on the healthcare

provision activities of the different branches of the Armed Forces and on sickness

insurance schemes through partnerships / alternative healthcare support systems

(ADME / ADMFA / ADMA), by type of assistance, namely:

Medicine products;

In-patient care;

Out-patient care;

Prosthesis equipment and stomatology;

Ancillary services;

Others (therapeutical, surgery, nursing care, others).

Reports and financial statements

The reports and financial statements published by various units contain specific

information on the financing of units and include:

Public social insurance subsystems in health, namely ADSE

ADSE is a public social insurance subsystem that partly finances the healthcare

expenditure of general government sector workers and is financed by transfers from

the state, contributions from employers in general government and, to a lesser

extent, contributions from beneficiaries. It establishes agreements and conventions

with healthcare providers belonging to the NHS or with other private providers such



as dispensing chemists, clinics and private hospitals. In addition, it subsidises

expenditure on health care in the case of beneficiaries resorting to health care

supplied by providers outside the NHS network and those operating under ADSE

agreements. Its annual report and financial statement provides detailed data on

healthcare expenditure on the NHS, either through agreements or on a free-access

basis, which enables financing to be attributed by provider.

Private social insurance subsystems, namely SAMS and the PT-ACS

The SAMS and PT-ACS private social insurance subsystems are both healthcare

providers and financers of their own production and that of other providers through

agreements and conventions.

The SAMS annual report and financial statement details the amounts of financing by

source of finance or, in other words, credit institutions, workers in general or special

schemes / complementarity, other users (insurance companies), the state and other

public bodies. It also provides a breakdown of the figures by type of service provided

outside the network of its own services and agreements.

The PT-ACS annual report and financial statement supplies the financing structure

for own production and the production of other healthcare providers within or outside

the network of agreements, by provider type.

For market production units organised as companies providing healthcare

services as a secondary activity, the financing amount was considered equal to

the estimated value of production. Occupational health units, for example, come

under this category.

Survey of private social solidarity institutions (I PSSs)

The survey provides detailed information on amounts received by households,

regional social security centres and other sectors.

Ministry of Finance

The Ministry of Finance has made available the total amount of health expenditure

that was considered for purposes of income tax deductions.



Report and Financial Statement of the Social Securi ty

The report and financial statement of the Social Security includes the amounts of

financing in health care expenditure under professional sickness and risks.

ISP statistical information on insurance / survey o f direct insurance

premiums, by policy and by holder

The annual report published by the ISP (the supervisory body for the insurance and

pension funds sector) supplies the direct insurance amounts paid, which are

equivalent to the amount disbursed by insurers on health insurance policies in

paying for the health care of beneficiaries, whether collective or individual policy

holders.

The results of the survey supplement the information obtained from the ISP,

enabling more detailed data to be obtained to meet the requirements of the National

Accounts.

Characteristics:

- Collection method: Sample

- Information collected from: Mainland Portugal

- Frequency of publication: Not published regularly

- Units surveyed: Companies

- Information collected by: Computer

The sources of information are presented in Annexe 16, under the classification

code for financer and provider.

3.4- Estimating healthcare expenditure by healthcar e function

(including related functions)

The shared structures provided by the various sources of information were used in

attributing values for healthcare expenditure on healthcare functions, with the

exception of related functions.



Certain problems emerged in relation to functional classification and its

correspondence to the ICHA-HC codes established in the SHA, due to the fact that

the information available was very limited and not always sufficiently well broken

down.

Whenever possible, the different structures were calculated by healthcare provider

type.

Situations exist in which the function corresponds directly to the goods and services

supplied by particular providers, as in the following cases:

ICHA-HP ICHA-HC

HP.4.1 HC.5.1

HP.4.2-HP.4.9 HC.5.2

HP.5 HC.6

HP.6 (HP.6.1; 6.3; 6.4; 6.9) HC.7

HP.7 HC.6

The main sources of information used in determining the structures of

healthcare functions were:

The Structural Business Survey (SBS)

The description of healthcare provider units included in the SBS in Specific Annexe

N – Health Care supplied detailed information on the types of services provided,

which were classified under the ICHA-HC nomenclature established in the SHA

manual.

The ICHA-HC references for classification were as follows:

SBS – Specific Annexe N: Health Care ICHA-HC

In-patient curative care HC.1.1/HC.3.1

out-patient care HC.1.3.1



(including stomatology and excluding dental medicine)

Emergency out-patient care HC.1.2

Medical dentistry and odontology HC.1.3.2

Nursing care HC.1.3.9

Ancillary services: HC.4

(including optometry), of which:

Clinical laboratory HC.4.1

Complementary therapeutical. HC.2.2/3

(including physiotherapy)

Survey on private social solidarity institutions (I PSSs)

The IPSS survey enabled main areas and the classification of healthcare functions

to be cross-referenced. The rules for cross-referencing are as follows:

Function Main area ICHA-HP ICHA-HC

Sickness In-patient care

Day cases of curative care

Out-patient care

Ancillary diagnosis services

Others

HP.1.1* / HP.2.3**

HP.1.1*

HP.1.1* / HP.3.4

HP.3.5

HP.5

HP.3.9

HP.2.3**

HC.1.1

HC.1.2

HC.1.2 / HC.1.3.1 /

HC.1.3.3

HC.1.3.1 / HC.1.3.3 /

HC.4.1

HC.6.3 / HC. 6.9

HC.4.3 / HC.4.9 / HC.

1.3.3

HC.1.3.1 / HC.1.3.3

Old age Homes for the elderly

Residential homes for the elderly

Home care

Other

HP.2.3

HP.2.3

HP.2.3

HP.2.3

HC.3.1

HC.3.1

HC.3.3

HC.3.1

Invalidity Home care

Residential homes

Rehabilitation centres for the blind

Others

HP.2.3

HP.2.2

HP.2.9

HC.3.3

HC.2.1/HC.2.2

HC.3.1 / HC1.3.9



Other

activities

Dispensing chemists HP.1.1* / HP.4.1 HC.5.1

* In the case of hospitals with different functions

** In the case of healthcare establishments for the elderly with in-patient hospital care, out-patient

care and others.

The PT-ACS annual report and financial statements

The PT-ACS private social insurance subsystem publishes detailed information on

the type of health care provided by its units. The following breakdown by healthcare

type may be obtained, corresponding to the following ICHA-HC classifications:

PT-ACS information ICHA-HC

Out-patient care – Clinical medicine HC. 1.3.1

Out-patient care – Stomatology and oral hygiene HC.1.3.2

Out-patient care – Specialists HC.1.3.1

Nursing care HC.1.3.9

General radiology HC.4.2

Cytology HC.4.1

Orthopaedics HC.2

Analysis (collection) HC.4.1

Auditory tests HC.1.3.1

E.C.G. HC.1.3.1

Panoramic radiography HC.4.2

Urofluxometry HC.4.1

Teleradiography HC.4.2

Information from IGIF

The IGIF supplied data on the healthcare structures of providers operating within the

NHS.

The methodology used by the IGIF to attribute NHS costs to a function classification

was as follows:



Based on the total values for consumption, supplies and external services and

expenditure on personnel contained in the “Global Financial Report of the NHS”,

which is published every year for each big group of providers (Hp1, HP3.4 and

others under the NHS), several criteria to impute to each item of expenditure at the

third or fourth level and for each were defined.

In order to do so, it was necessary to resort to other, more detailed sources of

information, such as the following:

♦ Cost accounting reports from central hospitals;

♦ Cost accounting reports from district hospitals;

♦ Cost accounting reports from level-one hospitals

♦ Report “NHS Transfers ”

♦ Costs reports for the following hospitals:

• Hospital São João, Hospital Universitário de Coimbra, Hospital Garcia da

Horta, Hospital Aveiro, Hospital Viseu, Hospital Alcobaça, Hospital Seia

♦ Costs of Hospital Magalhães de Lemos and Hospital Júlio de Matos

♦ Healthcare Statistics published by the INE for Health Centres.

Moreover for each of the items/sub-items analysed t he following procedure

was considered:

Consumption and breakdown by function:

Health Centres (HP3.4) : data in quantities supplied by INE, whenever available, on

the production of each medical procedure were converted into medical weighted

acts using the direct unit costs of level-one hospitals (previously council hospital

many times integrated in health centres).

An estimation of the unitary cost per item, by medical weighted act, multiplied by the

number of medical acts was made. For HC.6 (public health) an estimate of the

expenditure valued in terms of consumptions was made for the obligatory

vaccinations and the medical appointments carried out under public prevention



programs. These amounts were deducted to the total global costs of the out-patient

care estimates as referred in the previous paragraph

Hospitals (HP1) : Various direct cost items pertaining to the main hospital sections

were analysed, such as in-patient care, out-patient care, emergency out-patient

care, day cases of curative care and home care services, as broken-down in the

cost accounting reports of the central and district hospitals. The relative weighting of

each cost item was determined for each of the main sections, which was equivalent

to its functions.

Psychiatry (HP1) : Based on the cost of the sections of the psychiatric hospitals,, the

weight of the cost for each sub-item in each section, was estimated, These

weighters were applied as a structure to the total in each item.

Other autonomous services : There are several autonomous units and each has a

different purpose in its activity. After having analysed each unit in this group the

basic functions were defined. Then expenditure was directly attributed to each one in

terms of the functions defined.

External Services and Supplies:

There are two main different types of account with different nature:

Subcontracts that represent payments for services carried out by external

providers. Each of the sub-accounts was analysed in terms of the services

supplied (functions) by external providers. This analysis was applied to each of

the previously defined groups of services (hospitals, psychiatry, health centres

and other autonomous services). Therefore the actual amounts were allocated

directly to each function and each type of provider;

Supply of services covers the cost of services directly supported by institutions

during the exercise of their activities. In general, the same assessment was used

for all services in relation to each type of provider categorised under “Other



consumption". For other services, the real amounts corresponding to the

functional classification of each service were used.

Expenditure on employees and breakdown by function:

Efforts were made to break this account down into the main sub-items and also by

type of employee. For the headings “Wages and Salaries” and “Holidays and

Christmas Allowances” it was only possible to attribute by professional category.

Health Centres: Average weighted cost with employees were calculated and

applied to the previously estimated weighted medical acts according to the

conversion that was carried out. The total cost of employees was calculated by

function (HC1.1.1, HC1.1.3 e HC 1.1.4). In order to estimate the function HC6

(Prevention and public health), the number of employees working in this area was

taken into account and a ratio for the other “other employees” was estimated. The

average monthly unitary values paid in one of the five Regional Health

Administration was applied allowing the estimation of HC6. The difference between

the previously estimated amount for HC.1.1.3 and HC.6 was imputed to the function

HC.1.1.3 .

Hospitals : The breakdown of the cost of employees in the main sections of a group

of hospitals (the Hospital São João, Hospital Universitário de Coimbra, Hospital

Garcia da Horta, Hospital Aveiro and Hospital Viseu) was studied and the

assessment was established by function and sub-item. These weighters were

applied to the total cost.

Psychiatry : The breakdown of the cost of employees in the main sections was

studied. The criteria of the sub-items in each of the main sections, equivalent to

functions, were defined.

Other services : It was considered the actual amount of expenditure by item,

according to the initial functional classification, previously mentioned.



Other costs:

This item includes the following items: other operational cost e extraordinary cost

and losses (consolidated amounts imputed to each group of service).

Regional Health Administration (RHA) : Estimation of weighted average cost and

further multiplication by weighted medical acts, by function.

Hospitals, psychiatry and other services : Application of the weighters estimated

the cost in the item “other expenditure”.

Item “miscellaneous”: The analysis of the several components of this item allowed

the direct allocation to the respective function.

The figures for expenditure on healthcare-related functions were estimated

separately and considered only by financing agent, as in Table 5. However, in some

cases a lack of detailed information made it impossible to identify some related

functions. For example, even though it is known that hospitals and universities are

involved in healthcare research and development projects, this information is not

registered separately and it was therefore not possible to attribute this as a related

function under the SHA nomenclature.

ICHA – HC.R2 – Education and training of healthcare professionals: Production was

estimated according to the market or non-market classification and using the

methodology previously described.

ICHA – HC.R1 – Gross Fixed Capital Formation (GFCF) of providers: The estimated

expenditure was derived from the appropriation of figures made available by the

sources of information and the source of financing was later attributed:



ICHA-HF Source of information

HF.1.1.1 IGIF information – Appropriation of NHS

HF.1.1.3 Annual report and financial statements of other non-NHS

providers – Appropriation of Investment

HF.2.1 SAMS and ACS annual reports and financial statements –

Appropriation of Investment

HF.2.4 National Accounts by S15 sectors, branches 851 and 853 –

Figures for GFCF

HF.2.5 SBS, branches 851 and 853 – Appropriation of GFCF figures



3.5- Transitional matrices

The figures estimated for production and financing were entered into transitional

matrices giving details of the provider, financer and source of information.

The matrix for HP1 serves as an example.

Production side

HP1 - Hospitals – Estimated healthcare production Unit: 103 €

Sources of information

Production

Providers

Providers within the General Government

sector (including NHS

and others)

Corporations

Public and private social

insurance subsystems

in health

Providers belonging to

NPIS Total

Hospitals HP.1 3,001 3,001 General hospitals HP.1.1 331 27 78 436 Mental health and substance abuse hospitals HP.1.2

1 1

Speciality hospitals, except HP.1.2 HP.1.3

Total 3,001 332 27 78 3,438 Financing side

HP1 - Hospitals – Financing Unit: 103 € Sources of information

HF.1.1 HF.1.2 HF. 2.1 HF. 2.2 HF. 2.3

Providers

IGIF – other state

institutions

Total Survey on

IPSS information

Total

SAMS - Co-financed

expenditure (social

benefits in kind) +

production

Total

SAMS – Financing of

insurance companies

Total IGIF – Health fees

Total

Total

Hospitals HP.1 735 735 General Hospitals HP.1.1 3 2,055 0 0 11 24 3 45 18 66

2,390

Mental health and substance abuse hospitals

HP.1.2 1 57 0 1 0 0 0 3 63

Speciality hospitals, except HP.1.2

HP.1.3 0 210 3 4 0 2 1 7 250

Total 4 3,057 0 0 13 29 3 46 19 76 3,438



Note:

Due to the size of the transitional matrices, it was impossible to present the entire

table. The financing matrix is only an example and does not display all the sources

of information actually used.

The transitional matrices for the different providers served as a base for

consolidating results and for completing the tables displaying the results.



4. CONCILIATION OF RESULTS AND COMPILATION OF SHA

TABLES 2 TO 5

Producing the conciliated results with the final aim of completing SHA Tables 2 to 5

was an ongoing process involving various directly related and interdependent

phases of work:

1st phase: Determining equilibrium values of production and financing for each

provider and financing agent (Table 3);

2nd phase: Determining the healthcare function values (Table 2) by provider type;

3rd phase: Determining the financing values by healthcare function:

- grouped by mode of production (Table 4);

- Including related functions (Table 5).

As the work progressed, the results obtained in each phase enabled SHA Tables 2

to 5 to be completed. In the following sections a brief description of the tables will be

provided and the main features underpinning each of the phases of the work will be

explained.

4.1- Description of the tables

In this initial implementation phase of the pilot project Health Satellite Accounts it

was decided to complete SHA Tables 2 to 5 (in Annexes 1 to 4) as follows. The

tables describe the different dimensions of total healthcare expenditure according to

the circumstances they are intended to measure. This means that when the tables

are cross-referenced, the totals must remain identical in order to ensure consistency.

Table 2: Current expenditure on health by function of care and provider

industry



Table 2 describes the total uses of resident units of healthcare goods and services

by function of care and provider industry, at current prices.

Rows: - Health care by function – The different provider industries that supply each

of the healthcare functions.

Columns: - Healthcare provider industry – The different healthcare functions

supplied by each provider industry.

Data needs: It is necessary to obtain data on production by provider crosschecked

with expenditure by function or, in other words, expenditure is measured in terms of

the resources available for consumption by provider, by function.

Table 3: Current expenditure on health care by prov ider industry and sources

of funding

This table describes the total uses of resident units of healthcare goods and services

by provider industry and financing agent, at current prices.

Rows: - Health care by provider industry – The different financing agents that fund,

in various ways, each provider industry.

Columns: - Financing Agents – The different units that finance each provider

industry, by financing agent.

Data needs: It is necessary to obtain two kinds of information in order to complete

the table. On the one hand, information is required on the production of each

provider group, broken-down into the ICHA-HP nomenclature. These values fill the

rows.

The columns contain the expenditure of each financing agent by healthcare provider,

by each financer.



Finally, compilation of the table will consist of the reconciliation of data on resources

by provider, corresponding to production (total resources) or, alternatively, data on

expenditure by financing agent.

Table 4: Current expenditure on health by function of care and sources of

funding

It describes the total uses of resident units of healthcare goods and services by

function of care and by financing agent at current prices.

Rows: - Healthcare functions – The different financing agents for each healthcare

function.

Columns: - Financing agents – The different healthcare functions by financing

agents.

Data needs: The expenditure of each financing body by healthcare function or the

types of financing agents for each healthcare function. For the sake of consistency

between tables, the total expenditure obtained by financing agent must correspond

to the total in Table 3 and the total by function must correspond to the total obtained

in Table 2.

Table 5: Total expenditure on health, including hea lth-related functions

Table 5 describes the total expenditure on health including health-related functions.

Rows: - Healthcare functions, including related functions – The different financing

agents for each healthcare function.

Columns: - Financing Agents– The different healthcare functions by financing agents

Data needs: Partly corresponds to Table 4, but adds other items. It includes the

expenditure of each funding body by healthcare function, including related



healthcare functions or financing agents for each healthcare function, including

related healthcare functions.

4.2 - 1st Phase: Determining the balancing values of product ion and

financing for each provider and financing agent (Ta ble 3)

The first phase in the conciliation of results consisted in a process of calculating the

production / expenditure and financing values by type of provider and financing

agent.. It was decided to start the conciliation process by calculating the levels of

production and financing shown in Table 3, due to the availability of sources of

information and the links and correlations between its groupings and the other

tables.

The crosschecking of the figures supplied by the different sources of information on

financing and production was undertaken at the more detailed level of provider and

financing agent classification.

The analysis of sources of information was based on an assessment of how

representative and complete they were and, at the same time, the consistency of the

results was examined by crosschecking the different aspects of production and

financing. By respecting these quality criteria, a hierarchy of sources of information

was established.

For example, data supplied by the Ministry of Health (the IGIF and DGS), the

financial reports of government units, the public and private social insurance

subsystems, data on medicine products and health insurance were considered high

quality data and prioritised.

Levels of provider expenditure were established from the point of view of production

or financing, according to the quality of the information available. For some

providers, the total level was determined in terms of production, since the quality of

information was high. For others, the level was established in terms of financing

when the respective sources offered better quality information.



Relevant questions in relation to the conciliation of results in terms of provider

nomenclature:

HP.1 – Hospitals

The level of production for hospitals was established from the point of view of

production. In production estimates, preference was given to data from the SBS (in

the case of private hospitals), the IGIF (in the case of NHS hospitals), the SAMS

report and financial statement (in estimating its hospital production), the survey on

IPSSs, the reports and financial statements of healthcare institutions belonging to

the Santa Casa da Misericórdia (in the case of speciality and orthopaedic hospitals

and health centres), the reports and financial statements of the hospitals owned by

IPSL (not captured in the survey), the report and financial statement of the

Hospitals-Enterprise and the accounts of the hospitals and health centres in the

Autonomous Regions of Azores and Madeira.

In attributing values for funding, data from the IGIF prevailed in relation to funding for

NHS institutions; the financial reports for the hospitals and health centres in the

Autonomous Regions; the Ministry of Defence statistical yearbook in the values for

co-funding; the SAMS report and financial statement in the funding of the production

of its own hospital; the PT-ACS report and financial statement for co-financing of

other hospitals and the IPSSs for information on social security partnerships and

subsidies. In balancing the production and financing flows, the residual value was

attributed to NHS funding by other government bodies.

HP.2 – Nursing and residential care facilities

The production of nursing and residential care establishments was estimated from

the point of view of production, as the information on funding was considered

inadequate. Production estimates analysed the information from the SBS in the case

of private entities, the report and financial statement of SAMS to estimate production



in homes for the elderly with restricted access to retired workers, and the survey on

IPSSs to calculate the production of NPIs providing these services.

In relation to funding, the social security system, through partnerships and subsidies,

financed the NPI providing services in this area. ADSE, the public social insurance

subsystem, and SAMS, the private social insurance subsystem, jointly financed care

for the elderly. The remaining expenditure was supported directly by households.

HP.3 – Providers of ambulatory health care

The values for expenditure were determined from the point of view of production. On

the production side, priority was given to: information from the IGIF in the case of

NHS units; reports and financial statements from other government units within the

NHS, including the Autonomous Regions; the SBS in the case of private providers;

the PT-ACS and SAMS reports and financial statements; the survey of IPSSs for

NPI providers; and the production estimate for the “hidden economy” relating to the

self-employed and own-account workers who supply undeclared production,

including amounts relating to information originating from income tax returns.

In order to avoid duplicating the accounting of the production of the self-employed

and sole proprietors or, in other words, the intermediary production for other

providers, such as private offices and ancillary services, it was necessary to deduct

these amounts from the estimated production of the respective providers who were

self-employed or own-account workers. The amounts of “payments to own-account

workers” considered in the NHS, other public health care institutions, private

hospitals and other private producers were directly obtained from IGIF and reports

and financial statements and SBS, and deducted to the amount of output in HP3.

The “payments to own-account workers” accounted in providers of NPIS were not

separately available but were included in a total amount that also includes

subcontracts. Therefore the amount of “payments to own-account workers” were

estimated based on the production amount of own-account workers working in these

institutions and the estimated amount was deducted to the amount of output in HP3.

The diference between the total amount that includes also subcontracts and the



“payments to own-account workers” were considered as corresponding to

subcontracts.

The amounts concerning subcontracts of enterprises and public providers as well as

the estimated amount of subcontracts of NPIS were deducted to the output of the

respective providers to which they concern.

In relation to funding, attempts were made to achieve a partial balance between the

production and financing of the providers grouped under HP.3, such as:

Health care centres for out-patient included in the NHS (it includes the

Regional Health Administration (RHAs), the health centres of the Autonomous

Regions of Azores and Madeira and others) – Financing of production

Private social insurance subsystems in health (SAMS and ACS) – Financing

of own production

Corporations + government providers outside the NHS, such as:

The financing of private providers by the NHS and the public and

private social insurance subsystems in health – provision in the form of

subsidies (conventions and agreements with private providers) other

expenditure in favour of beneficiaries;

The financing of other government providers;

The financing of an additional value attributed to the “non-observed”

economy.

In relation to the health care centres for out-patient included in the NHS (it includes

the Regional Health Administration (RHAs), the health centres of the Autonomous

Regions of Azores and Madeira and others), the IGIF was considered the main

source of information, except in relation to ADSE, whose amounts were directly

taken from its report and, the Regional Health Services (RHS) of Azores and

Madeira. The value for NHS financing of the health care centres for out-patient

included in the NHS was derived from the difference between the output and the

remaining funding attributed to other sources of information.



Reports and financial statements provided information that enabled the financing of

the production of the PT-ACS and SAMS private social insurance subsystems to be

attributed.

The financing of the different private and government providers outside the NHS is

essentially based on the INE production estimates, the data supplied by the IGIF,

the Regional Health Services of Azores and Madeira, the Defence Ministry statistical

yearbook, the ADSE, PT-ACS and SAMS reports and financial statements, in

relation to funding of other providers, and production funding estimates for the

NPISHs based on the survey of IPSSs.

Based on information on financing supplied by the different sources mentioned

above and respecting the balance between production/expenditure and financing,

through direct allocation to the category of provider within HP3, the levels of

production/expenditure were determined with the following detail:

♦ Offices of doctors, of dental medicine, other providers of health care and

providers of home care - HP3.1, HP3.2, HP3.3, HP3.6;

♦ Health care centres for out-patient included in the NHS -_HP3.4;

♦ Other Health care centres for out-patient owned by private units and NPIS –

HP3.4;

♦ Medical and diagnostic laboratories;

♦ Other providers of ambulatory health care – HP3.9.

After obtaining all the financing flows from other bodies, such as the NHS, Regional

Health Services, the public and private social insurance subsystems in health, health

insurance, among all the sources that are available on financing and, considering

the enormous importance of the private sector in the provision of out-patient care

almost entirely borne by households, it was decided that the residual financing

required to balance the system should be attributed to private household

expenditure.



HP.4 – Retail sale and other providers of medical g oods

The value of HP.4.1 production was estimated from the point of view of production

and was derived from the direct appropriation of the figures supplied by INFARMED,

as it was considered that this was a source that was guaranteed to fully represent

the out-patient medicine products sector. In relation to financing, INFARMED was

also considered a quality source, since it publishes data on NHS, public (ADSE and

the Ministry of Justice) and private subsystems and patient costs. In relation to the

public schemes, information from the Ministry of Defence statistical yearbook was

also used.

The level of HP.4.2-HP.4.9 expenditure was determined from the point of view of

production, using the methodology previously described and favouring the IAPI and

final household consumption on the relevant products as sources of information. In

financing, information from the IGIF, in the case of the NHS and the Regional Health

Service of Azores and Madeira, prevailed,, and the reports and financial statements

of the schemes such as ADSE, ADME/FA/A, PT-ACS and SAMS who co-finance

this type of expenditure on the part of their beneficiaries.

The balance of the system, between production and financing, taking into account

the allocation of the financing amounts to the various different financial agents, was

established by considering the difference as the element pertaining to private

household expenditure. The amounts considered in this item concerned the

available data supplied by insurance companies on Prosthetics and Orthopaedic

appliances.

HP.5 – Provision and administration of public healt h programmes

Responsibility for the provision and administration of public health programmes is

attributed to the IPSSs. The amount of expenditure and the respective financing

were calculated in accordance with the production estimates for these institutions,

using the survey on IPSSs. The financing of production is divided between the

Department of Social Security, through partnerships and subsidies, and the NPIs

themselves in the financing of their own production.



HP.6. – General health administration and insurance

For all types of administration and insurance, the level of expenditure was estimated

from the point of view of production. The balance between production and financing

health administration by the government, other forms of social insurance and the

remaining healthcare providers (except for social security) was obtained through the

balance between production and the necessary resources it requires.

HP.7 – Other industries

The levels of production for occupational healthcare provider establishments were

established from the production side. This includes the information taken from the

reports and financial statements of specific companies and the production estimates

for medical units belonging to other private companies, local government, the PSP

and GNR and other government units. The amounts were derived from the

application of the methodology described in Section 3.2. Financing was considered

to have been carried out through financial agents responsible for supporting

expenditure on their production.

Other industries which are secondary producers of health care include universities

and higher education establishments which administer areas related to health care,

and prison and military hospitals, on the assumption that they offer restricted access

to particular groups and are part of other institutions and organisations. In the case

of prison and military hospitals, production was estimated on the basis of information

included in the General Account of the State and financing was established by levels

of production. In universities and higher education institutions, the outputs were

estimated using, preferentially, the results of the SBS; the reports and financial

statements of some private universities that were not included in the SBS but

classified as corporations; the IGIF and the reports and financial statements of the

universities and higher education institutions included as NPIs. The figures for

financing were based on the different sources of information and the residual value

was attributed to the other government units.



HP.9 – Rest of the world

The production of foreign providers in the provision of healthcare services for

national patients was estimated from the point of view of financing. In calculating

expenditure, as there was no information available on the level of production,

information from the IGIF was used, namely the amounts featuring in EU regulations

and in foreign assistance requested by national hospitals from foreign hospitals, and

from the payments and amounts shared with the public ADSE and the private SAMS

subsystems.

The different sources of information used in attributing healthcare expenditure by

provider and by source of funding are presented in Annexe 16.

Table 3 was completed at the same time as the balancing figures for production and

financing were established. Table 3 only records the provision of healthcare services

and does not consider the production of related activities such as GFCF and the

education and training of healthcare personnel.

4.3 - 2nd Phase: Determining expenditure values by healthcar e

function and by provider type (Table 2)

After establishing expenditure by provider group and by source of funding in Table 3,

it was then distributed by healthcare function.

In the case of the NHS, the IPSS hospitals and corporations, direct use was made of

the available information to allocate the expenditure figures for these providers.

In situations where there was no information that would enable the total expenditure

of each provider to be directly allocated to the respective functions, it was necessary

to resort to representative divisional structures originating from the previously

described sources of information that were available. For example, to create the



functional division of production of military hospitals classified as HP.7.9, the similar

general hospital structures supplied by the IGIF were used.

When healthcare expenditure by providers corresponded solely to a particular

function, the figures were used and attributed directly.

The sources of information used to attribute healthcare expenditure by provider and

by function are presented in Annexe 17.



4.4 - 3rd Phase: Determining the funding values by healthcar e

function (Tables 4 and 5):

- Grouped by production (Table 4)

- Including related functions (Table 5)

The third phase of the work was based on calculating the expenditure values by

financing agent and by healthcare function.

In the process of dividing the total expenditure values, the final results of Table 3,

provider versus source of funding, and of Table 2, providers versus healthcare

function, were considered.

Table 3 Table 2

Table 4 and Table 5

HF.

HC

Total current healthcare expenditure HF.1 HF.1.1 ….. HF.3

HC. 1.1; 2.1; ΣHC.1.1; 2.1 HC.1.1;2.1; HF.1 HC.1.1;2.1; HF.1.1 …… HC.1.1;2.1; HF.3

HC.3.1 ΣHC.3.1 HC.3.1; HF.1 HC.3.1; HF.1.1 …… HC.3.1; HF.3

. Σ . . …… .

HC.7 ΣHC.7 HC.7; HF.1 HC.7; HF.1.1 …… HC.7; HF.3

ΣHF.1. ΣHF.2. …… ΣHF.3.

The following methodology was adopted:

1. In relation to the individual provider, the common element in Tables 2 and 3, total

values by healthcare function and by sources of funding were considered. Efforts

were made to ensure that the total functional and financing amounts in Tables 4

HF.

HP HF.1 HF.1.1 ….. HF.3

HP.1 HP.1; HF.1 HP.1; HF.1.1 …… HP.1; HF.3

HP.2 HP.2; HF.1 HP.2; HF.1.1 …… HP.2; HF.3

. . . …… .

HP.9 HP.9; HF.1 HP.9; HF.1.1 …… HP.9; HF.3

ΣHF.1. ΣHF.2. …… ΣHF.3.

HP. HC

Total current healthcare

expenditure HP.1 ….. HP.9 HC. 1.1;

2.1; ΣHC.1.1; 2.1 HC.1.1, 2.1; HP.1 ……. HC.1.1, 2.1; HP.9

HC.3.1 ΣHC.3.1 HC.3.1; HP.1 ……

. Σ . …… .

HC.7 ΣHC.7 HC.7; HP.1 …… HC.7; HP.9



and 5 respected the total functional values in Table 2 and the total financing

values in Table 3, thus maintaining the balance of the system. Although Tables 4

and 5 did not display data on expenditure by healthcare provider, due to a lack of

information directly relating healthcare functions to financing, it was understood to

be essential to the total results by provider.

2. The total funding values by provider type featured:

- Direct correspondence between provider / specific function / sources of funding.

Example:

Table 3: HP.4.1� HF.1.1.1 / HF.1.1.2 / HF.2.1 / HF.2.2 / HF.2.3

Table 2: HP.4.1� HC.5.1

Tables 4 and 5: HC.5.1� HF.1.1.1 / HF.1.1.2 / HF.2.1 / HF.2.2 / HF.2.3

- The application of divisional structures provided by the different sources of

information. Concerning the hospitals included in the NHS and the related

amount in the State Budget the annual reports on the “Criteria of Financing of

Hospitals” was used as a reference because it makes the correspondence

between the functions of production and the respective financing.

In this case, the nature of the different providers, i.e. whether they belonged to

the NHS, the private and public social insurance subsystems in health or the

private sector, was respected. Whenever possible, the values for financing were

split by function in accordance with this criterion and the respective or

representative divisional structures were applied.

3. In the process of adjusting the sum of the partial values for financing expenditure

by function to their total values with the aim of balancing the system, the

differences resulting from the application of structures were, in some cases,

attributed to private household expenditure and in other cases to the NHS.

The sources of information used in dividing healthcare functions by source of

information in terms of the different health care providers are presented in Annexe

18.



When the process of allocating financing by healthcare function was complete, the

figures were aggregated in accordance with the criteria required for compiling Tables

4 and 5. In Table 4, the expenditure amounts of the different healthcare functions

were grouped by mode of production, such as in-patient services, out-patient

hospital day-care and domiciliary services. In Table 5, information on health-related

functions was added, by sources of funding.

5. LIMITATIONS

Certain practical and conceptual limitations emerged during the process of

implementing the Health Satellite Account.

The ideal aim was to obtain linear correspondence between the national healthcare

system, in terms of its organisation, institutional relationships and financial flows,

and the system of healthcare accounting proposed by the SHA, in terms of its

concepts and nomenclature, but this was not always achieved. This is due to the fact

that an accounting system is created with the aim of providing a general picture of

the main, shared characteristics of different countries, without taking the specific

characteristics of each one into account. Therefore, there will always be limitations

and a need to adapt and adjust international principles and presuppositions to

different national circumstances. Ultimately, it may be said that even if the

healthcare system is effectively portrayed through the structural methodology

proposed by the SHA, conceptual problems will still remain due to the unavailability

of statistical data or sources of information. However, it was accepted that this

limitation may easily be overcome by using alternative sources of information,

adapting existing sources or creating new questionnaires.

The main limitations were as follows:



The classification of the units in the universe in accordance with the

nomenclature proposed in the SHA manual, using the CAE-Rev. 2.1

Classification of Economic Activities criteria is very limited since, even with the

CAE-Rev. 2.1 breakdown into five digits, it does not meet the requirements for

detailed information stipulated in the SHA. In the specific case of identifying the

activities of individually-registered businesses and their subsequent classification

by provider and function using only the general CAE classification and with no

recourse to additional information, the difficulties were even greater.

In this initial stage of the development of the work it was only possible to detail

the amounts of expenditure in HP.3 (Providers of out-patient health care) into five

main subcategories. The amounts were obtained in the conciliation of the data on

financing and production at the level of each provider. The estimation of the

expenditure at the most detailed level of the subcategories of HP3 became a

difficult task due to the characteristics of national healthcare system that is not

organised very homogenously, meaning that it is not always possible to break

down information according to the requirements of the SHA HP.3 classification.

In fact, many healthcare units are organised as “health centres" in which various

healthcare providers and services are concentrated.

For example:

According to SHA guidelines, offices of physicians should be classified under

HP.3.1 and offices of dentists under HP.3.2. However, in practice medical

offices offer both doctors' and dentists' services and should be classified

under HP.3.4;

Situations where dentists, stomatologists and odontologists practice in the

same office. Stomatologists and odontologists should be classified under

HP.3.1 and dentists under HP.3.2. There are many queries about

classification within the HP level and, in this case, they were eventually

classified under HP.3.4.;



Generally in nursing centres other services are also offered, such as

diagnostic tests, specialist medical appointments, etc.

Moreover, there is no information to clarify this situation with regard to funding. It is

possible to identify the amounts paid by the NHS and the public and private social

insurance subsystems for a particular healthcare service, but impossible to

determine clearly which healthcare provider unit is destined to receive them. To

make matters even more complicated, there is no information available on private

household expenditure.

In HP.2 it was not possible to separate the expenditure on health care provided

by homes for the elderly and residential homes for the elderly. In practice, there

are few entities involved in social work with the elderly who have their own

healthcare units in Portugal. In most cases when it is necessary to seek

healthcare services they resort to the NHS or the private sector providers. In

addition, when health care is provided within these institutions, it is difficult to

separate social work from health care..

The functional classification is ambiguous and subjective, giving rise to certain

conceptual doubts. There are certain situations in which it is possible to classify

some healthcare services under more than one ICHA-HC code, as there is no

more detailed information that would allow them to be allocated more precisely.

For example:

It is difficult to separate long-term nursing care from curative care and

rehabilitation. In most cases, there is no information available to clarify this point.

In these cases, the criterion of "common sense" was applied;

There are some uncertainties in the structures of the health care in the Hospitals

(HP1) as regarding whether the ancillary services should be classified under the

function HC4 (Ancillary services in health) or under HC1.3 (Out-patient care),

namely in HC1.3.1.



In methodological terms the SHA manual is clear regarding the allocation of

services of health care intended to intermediate consumption of the providers in

terms that they should be recorded separately, considering that they are part of

the final product. In practice the definition of HC1.3.1 the basic medical services

of diagnosis and therefore when the ancillary services are provided under an

episode of out-patient care should be there included.

If one considers that the health care services provided under in-patient care are

undoubtedly there included then the same should happen to the same type of

services under out-patient care.

In particular, the problem focuses in whether ancillary services, such as

diagnosis, provided by hospitals should recorded as HC4 or as intermediate

consumption of health services of in-patient and therefore recorded under

HC1.3.1.

From the available data sources it is possible to obtain the amounts of diagnosis

services that are invoiced under out-patient as they are recorded separately

under a sales item. However the option should be the separation of all the

diagnosis services in a Hospital then it would be difficult to isolate the amount of

diagnosis services under in-patient. Nevertheless it could be done for public

hospitals requiring additional work.

As previously mentioned it is easy to obtain data for ancillary services separately

in out-patient, but it is difficult to isolate the respective amount for in-patient

because in terms of the cost accounting of the hospitals in-patient is considered

as a “pure service” equivalent to an episode. In private hospitals, the situation is

the same.

Should the classification of all ancillary services in HC4 the option adopted then

it will be possible to do it for public hospitals, by using their detailed cost

accounting, but it will not be possible for the private hospitals where such data

are not available.

It was impossible to exclude the amount of expenditure on terminally-ill in-

patients from in-patient curative care, as no information was available;



It is not clear how the expenditure on rehabilitation for the blind should be

classified. Apparently it should be classified under HC.1.9 but it could also be

allocated to HC.2;

It was not possible to break down function HC.1.3, out-patient curative care, into

its components - basic medical and diagnostic services, out-patient dental care,

all other specialised health care and all other in-patient curative care - as the

requisite information was not available.

The resolution of problems relating to functional classification will involve adapting

and revising the ICHA-HC nomenclature to fit the circumstances and, at the same

time, making efforts to obtain data that will meet the information needs.

The amounts concerning the NHS for output/expenditure are on an accrual basis.

However the amounts on financing for the same providers are on a “cash basis”

meaning that they do not fully reflect the accounting period and therefore distort

the figures for some financing agents. It is expected to have an improvement in

this situation due to the Public Official Accounting Plan in Health that is into force

since 2003.

The estimation of the production of the households in home care (personal care)

to their relatives temporarily or long-term care is underestimated but due to

conceptual reasons considering that this is the SHA rule. Therefore, according to

SHA, the amounts considered correspond to the social transfers to the

households that provide home care (personal care) to their families. The eligibility

criterion of these transfers is not associated at all to th corresponding “imputed

production”.

With regard to the registration of expenditure by units responsible for the

administration of social protection, particularly the administration of the public

and private social insurance subsystems registered under HP.6.3 and HP.6.4,

respectively, the SHA manual states explicitly that only administrative services



must be registered. From a conceptual point of view this approach may not be

correct, particularly for those who may be both financers and providers. From a

practical point of view, it is not viable to isolate the administrative services to

record them under the provider category HP.6.3 and HP6.4. In the case where

units both provide and finance, administration is an ancillary activity and isolating

it does not make economic sense, that is, it is conceptually meaningless. It only

makes sense to include in HP.6.3 and HP.6.4 the social insurance subsystems

that finance health care only.

6. DIFFERENCES BETWEEN THE NATIONAL ACCOUNTS AND THE

HEALTH SATELLITE ACCOUNT

The main differences between the National Accounts and the Health Satellite

Account which explain why separate results are obtained are as follows:

Level of correspondence: There is no direct correspondence between the Health

Satellite Account and Section 85 – Health Care and Social Work. The Health

Satellite Account covers the whole of Section 851 – Health Care – and part of

Section 853 – Social Work related only to health care;

Statistical Units in Section 851: The National Accounts include forensic medicine

institutes in Section 851, as recommended by EUROSTAT. These were,

however, excluded form the Health Satellite Account due to the specific nature of

their activities. Nevertheless it is important to analyse this question, given that

these units employ workers who are connected to health care.

Methodologies and concepts: (of non-market producers)

§5.26 recommends that the output of retailers is measured by trade and

distribution margins. However this option was not adopted, as it was not

considered completely correct. The output versus expenditure has to be

balanced or, in other words, the value of goods and services used in



consumption must be equal to the value of the resources available for

consumption by resident households.



CCHHAAPPTTEERR IIIIII –– FFUUTTUURREE PPRROOJJEECCTT DDEEVVEELLOOPPMMEENNTTSS Future methodological developments should be based on improving the quality of

the results of the Health Satellite Accounts and will take the following into account:

The production of methodological studies on particular areas of health care with

the aim of overcoming the limitations of the ICHA classification system and the

estimates of production, funding and health care;

The search for alternative sources of information in areas where there are gaps;

Improvements to the information made available by the existing sources;

Compilation of new tables envisaged in the SHA manual, namely Table 8, with

information relating to price indices, and Table 10, containing employment data

and, table 7, containing information on expenditure by gender and age, in order

to supplement the information to provide a more in-depth economic analysis of

the sector.

The methodology presented in the document was used to estimate the definitive

accounts for 2000, 2001 and 2002. At the same time price and volume indices were

estimate for the period 2000-2003. Therefore it is important to an indepth analysis of

the estimated results, namely the deflated figures of expenditure in health care

through the price and volume indices obtained. It is rather important to analyse the

growth and behaviour of the main variables that explain the expenditure in order to

assess the quality of the results.

Simultaneously the methodology of estimating provisional Health Accounts was also

developed, namely for 2003 where the main components of the expenditure were

calculated by using indices and structures in health care. Nevertheless the

development of the methodology to compile provision Health Accounts will very

much rely on the conclusions of the exhaustive analysis of the results of the

definitive accounts associated to the estimated price and volume indices.

The results of the provisional accounts will meet the data needs for the most recent

years, namely after 2002. For instance, the reply of the joint questionnaire



OECD/EUROSTAT/WHO “SHA Data Collection” will be based on the preliminary

results for the Health Accounts for 2004.

Furthermore these preliminary data will be converted into provisional and will

become definitive through the update and integration of the final data taken directly

from data sources when the definitive National Accounts are available for purposes

of confrontation.

The level of detail obtained in the results of the Health Satellite Account will depend

on the sources of information available, given that final the objective of the project is

to comply as closely as possible with the details of the ICHA nomenclature.

The Health Satellite Account was compiled in terms of national territory. However, in

future there are plans to move towards regionalising of the Account, with the first

phase based on NUTS I (Mainland, Azores and Madeira), followed by NUTS II

(Norte, Centro, Lisboa, Alentejo and Algarve).

In the short term, assuming the same resources are available, the following are

considered feasible:

Compiling of the Preliminary Account for 2004 and later the Provisional Account

for the same year (SHA Tables 2-5);

Compiling of the Preliminary Account for 2005 (SHA Tables 2-5);

Compiling of the Definitive Account for 2003 (SHA Tables 2-5);

Improvement of the methodology at the level of the imputation of the expenditure

figures by function of health care and provider;;

Estimation of price and volume indices for 2004.

Assuming that resources are consolidated:

Compilation of table 7 in SHA (expenditure by age and gender);

Completing Table 10 (employment);

Set up of a database for the Health Accounts.





AANNNNEEXXEE 11:: TTAABBLLEE 22.. CCUURRRREENNTT EEXXPPEENNDDIITTUURREE OONN HHEEAALLTTHH BBYY FFUUNNCCTTIIOONN OOFF CCAARREE AANNDD PPRROOVVIIDDEERR IINNDDUUSSTTRRYY

Healthcare provider industry Other industries Row

HP

.1

HP

.2

HP

.3

HP

.3.1

HP

.3.2

HP

.3.3

HP

.3.4

HP

.3.5

HP

.3.6

HP

.3.9

HP

.4

HP

.4.1

HP

.4.2

-4.

9

HP

.5

HP

.6

HP

.6.1

HP

.6.2

HP

.6.3

HP

.6.4

HP

.6.9

HP

.7

HP

.9

Health care by function ICHA-HC

code Hos

pita

ls

Nur

sing

and

res

iden

tial c

are

faci

litie

s

Pro

vide

rs o

f am

bula

tory

hea

lth

care

Offi

ces

of p

hysi

cian

s

Offi

ces

of d

entis

ts

Offi

ces

of o

ther

hea

lth

prac

titio

ners

Out

-pat

ient

car

e ce

ntre

s

Med

ical

and

dia

gnos

tic

labo

rato

ries

Pro

vide

rs o

f hom

e he

alth

care

se

rvic

es

All

othe

r pr

ovid

ers

of o

ut-

patie

nt h

ealth

car

e

Ret

ail s

ale

and

othe

r pr

ovid

ers

of m

edic

al g

oods

Dis

pens

ing

chem

ists

All

oth

er s

ales

of m

edic

al

good

s

Pro

visi

on a

nd a

dmin

istr

atio

n of

pu

blic

hea

lth p

rogr

amm

es

Gen

eral

hea

lth a

dmin

istr

atio

n an

d in

sura

nce

Gov

ernm

ent a

dmin

istr

atio

n of

he

alth

Soc

ial s

ecur

ity fu

nds

Oth

er s

ocia

l ins

uran

ce

Oth

er (

priv

ate)

insu

ranc

e

All

othe

r he

alth

adm

inis

trat

ion

All

othe

r in

dust

ries

Res

t of t

he w

orld

In-patient care Curative and rehabilitative care HC.1.1; 2.1 Long-term nursing care HC.3.1

Services of day care (out-patient)

Curative and rehabilitative care HC.1.2; 2.2

Long-term nursing care HC.3.2

Out-patient care Curative and rehabilitative care HC.1.3; 2.3 Basic medical and diagnostic services HC.1.3.1

Out-patient dental care HC.1.3.2

All other specialised health care HC.1.3.3

All other long-tern curative care HC.1.3.3

Home care

Curative and rehabilitative care HC.1.4; 2.4

Home care HC.3.3

Ancillary services to health care HC.4

Medical goods dispensed to out-patients HC.5

Pharmaceuticals and other non-durable medical

goods HC.5.1

Therapeutic appliances and other medical durables HC.5.2

Total expenditure on personal health care Prevention and public health services HC.6 Health administration and health insurance HC.7 Total current expenditure on health care



AANNNNEEXXEE 22:: TTAABBLLEE 33.. CCUURRRREENNTT EEXXPPEENNDDIITTUURREE OONN HHEEAALLTTHH BBYY PPRROOVVIIDDEERR IINNDDUUSSTTRRYY AANNDD SSOOUURRCCEESS OOFF FFUUNNDDIINNGG

HF.1 HF.1.1 HF.1.2 HF.2 HF.2.1 + HF.2.2 HF.2.3 HF.2.4 HF.2.5 HF.3 HF.1.1.1 HF.1.1.2 HF.1.1.3 HF.2.1 HF.2.2

Total current expend

iture on

health

General government

General government (excluding

social security funds)

NHS

Public social

insurance subsystem

s

Other government units (other than HF.1.2)

Social security funds

Private sector

Private insuran

ce

Private social

insurance

Private social

insurance subsystem

s

Other private insuran

ce

Private household out-of-pocket

expenditure

NPISHs (other

than social

insurance)

Corporations (other

than health insurance)

Rest of the

world

Health care goods and services by provider industry

Hospitals HP.1 Nursing and residential care facilities HP.2

Providers of ambulatory health care HP.3

Offices of physicians HP.3.1 Offices of dentists HP.3.2 Offices of other health practitioners HP.3.3

Out-patient care centres HP.3.4

Medical and diagnostic laboratories HP.3.5 Providers of home healthcare services HP.3.6 Other providers of ambulatory health care HP.3.9

Retail sale and other providers of medical goods HP.4

Dispensing chemists HP.4.1 All other sales of medical goods HP.4.2-

4.9

Provision and administration of public health

programmes HP.5

General administration and health insurance HP.6

Government (excluding social security) HP.6.1

Social security funds HP.6.2 Other social insurance HP.6.3 Other (private) insurance HP.6.4 Other providers of health administration HP.6.9

All other industries HP.7 Occupational health care HP.7.1 Households providing home care HP.7.2

All other secondary producers HP.7.9

Rest of the world HP.9



AANNNNEEXXEE 33:: TTAABBLLEE 44.. CCUURRRREENNTT EEXXPPEENNDDIITTUURREE OONN HHEEAALLTTHH BBYY FFUUNNCCTTIIOONN OOFF CCAARREE AANNDD SSOOUURRCCEESS OOFF FFUUNNDDIINNGG HF.1 HF.1.1

HF.1.2 HF.2 HF.2.1 + HF.2.2 HF.2.3 HF.2.4 HF.2.5 HF.3

HF.1.1.1 HF.1.1.2 HF.1.1.3 HF.2.1 HF.2.2

T

otal

exp

endi

ture

General government

General government (excluding

social security funds)

NHS Public social


Other general government units (except

HF.1.2)


Private sector

Private insurance

Private social

insurance

Private social


Other private

insurance

Private household

out-of-pocket

payments

NPISHs (other than

social insurance)

Corporations (other than

health insurance)

Rest of the world

Current expenditure on health care

Personal healthcare services HC.1-HC.3

In patient services

Day-care services

Out-patient care

Home care


Medical goods dispensed to out-patients

HC.5

Pharmaceuticals and other non-

durable medical goods HC.5.1

Therapeutic appliances and

other medical durables HC.5.2

Personal care goods and services HC.1 – HC.5

Prevention and public health

services HC.6

Health administration and health insurance

HC.7



AANNNNEEXXEE 44:: TTAABBLLEE 55.. TTOOTTAALL EEXXPPEENNDDIITTUURREE OONN HHEEAALLTTHH IINNCCLLUUDDIINNGG HHEEAALLTTHH--RREELLAATTEEDD FFUUNNCCTTIIOONNSS

HF.1 HF.1.1 HF.1.2 HF.2 HF.2.1 + HF.2.2 HF.2.3 HF.2.4 HF.2.5 HF.3 HF.1.1.1 HF.1.1.2 HF.1.1.3 HF.2.1 HF.2.2

Tot

al e

xpen

ditu

re

General governmen

t

General government

(except social

security funds)

NHS

Public social

insurance subsystem

s

Other government units (except

HF.1.2)


Private sector

Private insuranc

e

Private social

insurance

Private social

insurance

subsystems

Other private

insurance

Private household

out-of-pocket

payments

NPISHs (other

than social insurance)


health insurance)

Rest of the world

Healthcare services and gods by function Curative and rehabilitative care HC.1,

HC.2

Long-term nursing care HC.3


Medical goods dispensed to out-patients

HC.5

Pharmaceuticals and other non-

medical durables HC.5.1

Therapeutic appliances and other medical durables

HC.5.2

Personal medical services and goods

HC.1 – HC.5

Prevention and public health services

HC.6

Health administration and health insurance

HC.7

Total current expenditure on health care

Gross capital formation HC.R.1 Total expenditure on health

Health-care-related functions Education and training of health personnel

HC.R.2

Research and development in health HC.R.3 Food, hygiene and drinking water control

HC.R.4

Environmental health HC.R.5 Administration and provision of social services in kind to assist living with disease and impairment

HC.R.6

Administration and provision of health-related cash benefits

HC.R.7



AANNNNEEXXEE 55:: IICCHHAA--HHPP –– CCLLAASSSSIIFFIICCAATTIIOONN OOFF HHEEAALLTTHHCCAARREE PPRROOVVIIDDEERRSS

HP code Healthcare providers HP description

HP.1 Hospitals. Includes healthcare establishments licensed as “hospitals”, primarily engaged in providing in-patient services. If the healthcare establishment offers in-patient care only as a secondary activity, and essentially provides out-patient services, it should not be included in this item but in a sub-section of HP.3. Health centres, i.e. public healthcare establishments administered by RHAs, some of which have in-patient facilities, should be classified under HP.3.4.9 as their main activity is the provision of out-patient health care.

HP.1.1 General hospitals. All non-specialist hospitals (including those offering medical training).

HP.1.2 Mental health and substance abuse hospitals.

Includes hospitals specialising in psychiatry and recovery programmes for alcoholics and the rehabilitation of drug addicts.

HP.1.3 Speciality (other than mental health and substance abuse) hospitals.

Includes hospitals specialising in infectious diseases, maternity care, ophthalmology, oncology, orthopaedics, paediatric medicine, pneumology, rehabilitation for the physically disabled, rheumatology and terminal illnesses, amongst others.

HP.2 Nursing and residential care facilities.

Establishments offering in-patient nursing care, such as rest or convalescent homes, homes for the elderly, hospices – all involving essentially long-term nursing care in which the “residential” or ”social” aspect is not predominant; Residential establishments offering specialist domiciliary care for the mentally retarded, mental health patients, drug addicts and alcoholics – all involving essentially “residential” and “social” care – may or may not offer their own healthcare services. In both cases these are not considered to involve specialist in-patient medical treatment, otherwise they would have been classified under HP.1.2.

HP.2.1 Nursing care facilities. Establishments offering in-patient nursing care: rest or convalescent homes, homes for the elderly, hospices, teaching nursing homes (involving essentially long-term nursing care in which the “residential” or “social” aspect does not predominate).

HP.2.2 Residential mental retardation, mental health and substance abuse facilities.

Establishments offering residential services and specialist domiciliary care to the mentally retarded, mental health patients, drug addicts or alcoholics – all providing essentially “residential” or “social” services – and which may or may not have their own healthcare services. Does not include the specialist medical in-patient treatment classified under HP1.2 and the specialist medical out-patient treatment classified under HP3.4.2.

HP.2.3 Community care facilities for the elderly.

Community care facilities for the elderly: establishments providing essentially “residential” or ”personal care” services, which may or may not provide their own nursing care.

HP.2.9 Other residential care facilities, n. e. c.

All the remaining establishments offering residential care, including homes for the hearing and visually impaired and the physically disabled, which may or may not have their own nursing care and where essentially “residential” or “personal care” services are provided.

HP.3 Providers of ambulatory health care.

Out-patient healthcare providers (predominantly ambulatory).

HP.3.1 Offices of physicians. Consultancies or offices of general or specialist medical practitioners, either in private practices or in other healthcare establishments, out-patient healthcare providers, including stomatology and odontology.

HP.3.2 Offices of dentists. Medical dentistry (dentists) consultancies or offices, either in private practice or in other establishments, offering out-patient healthcare services, excluding stomatology and odontology.

HP.3.3 Offices of paramedical practitioners.

Nurses and paramedics such as chiropractors, optometrists, mental health specialists, (non-medical) physiotherapists, occupational therapists, speech therapists, audiologists, (non-medical) acupuncturists, dental hygienists, dentists, dieticians, homeopaths, respiratory therapists, midwives, naturopaths – in private practice or in other establishments and offering out-patient healthcare services.



HP.3.4 Out-patient care centres. Includes family planning centres, mental health (psychiatric) and substance abuse centres, ambulatory surgery centres, haemodialysis centres, care centres and all other outpatient multi-speciality and co-operative service centres

HP.3.4.1 Family planning centres. Pregnancy counselling centres, birth control clinics, childbirth preparation classes and fertility clinics.

HP.3.4.2 Out-patient mental health (psychiatric) ands substance abuse centres.

Out-patient mental health (psychiatric) centres and alcoholism and drug addiction treatment centres.

HP.3.4.3 Free standing ambulatory surgery centres.

Centres providing out-patient surgery.

HP.3.4.4 Haemodialysis centres. Haemodialysis centres (out-patient).

HP.3.4.5 All other out-patient multi-speciality and co-operative centres.

Other centres providing out-patient specialist and co-operative care.

HP.3.4.9 All other out-patient care centres. All other out-patient integrated community healthcare centres Includes all "health centres" administered by RHAs.

HP.3.5 Medical and diagnostic laboratories.

Diagnostic imaging centres, medical or dental X-ray laboratories, medical testing laboratories, medical pathology laboratories morbid anatomy, histopathology and thanatology (forensic medicine) laboratories.

HP.3.6 Providers of home healthcare services.

Providers of: nursing care; personal care services, counselling and advice, physical therapy, medical social services, 24-hour home care, occupational and vocational therapy, dietary and nutritional services, speech therapy, audiology and hi-tech care (such as intravenous therapy).

HP.3.9 Other providers of ambulatory health care.

Ambulance services (including air transport); blood, other human fluids and organ banks; all other ambulatory services (not included in previous items): health screening services (except by offices of health practitioners), hearing tests (except by audiologists), smoking cessation programmes; pacemaker monitoring services; physical fitness services (except by doctors).

HP.3.9.1 Ambulance services. Includes air transport.

HP.3.9.2 Blood and organ banks. Banks for storing blood and blood products, other human fluids and human organs.

HP.3.9.9 providers of all other ambulatory healthcare services.

All other out-patient healthcare services (not included in previous items): health screening services (except by offices of health practitioners), hearing tests (except by audiologists), smoking cessation programmes; pacemaker monitoring services; physical fitness services (except by doctors).

HP.4 Retail sale and other providers of medical goods

Establishments whose primary activity consists of the retail sale of medical goods to the general public for personal or household consumption or utilisation. Maintenance and repair work are included as well as sales.

HP.4.1 Dispensing chemists. Public dispensing chemists, excluding hospital dispensing chemists, which are classified under HP.1 and including the sale of prescription or non-prescription medicinal and pharmaceutical products.

HP.4.2 Retail sale and other providers of optical glasses and other vision products.

Oculists (sale, maintenance and repair).

HP.4.3 Retail sale and other providers of hearing aids.

Specialist establishments supplying hearing aids (sale, maintenance and repair).

HP.4.4 Retail sale and other providers of medical appliances (other than optical products and hearing aids).

Establishments whose principal activity is the retail sale of medical appliances (other than optical products and hearing aids) to the general public, including dentures, standard or equivalent products for personal or household use and consumption (including their maintenance and repair).

HP.4.9 All other miscellaneous sales and other suppliers of pharmaceuticals and medical goods (including shops, electronic shopping and e-mail orders).

Examples: sale of fluids (for home dialysis); electronic sale of pharmaceuticals and/or medical goods by specialist mail-order houses.

HP.5 Provision and administration of public health programmes.

Provision and administration of government or private public health programmes such as health promotion and protection programmes, collective public hygiene programmes, etc.



HP.6 General health administration and insurance.

Establishments whose primary activity is the regulation of the activity of agencies providing health care, overall administration of health policy and health insurance.

HP.6.1 Government administration of health [except social security]

Government health administration (excluding social security) primarily engaged in the formulation and administration of government policy in health and in setting and enforcing standards for medical and paramedical personnel in healthcare establishments (hospitals, etc.), as well as regulating and licensing providers/suppliers of healthcare services: the Ministry of Health and its specialist departments.

HP.6.2 Social security funds. Funding and administration of compulsory (government) social security programmes compensating for reduction or loss of income due to sickness: social security sickness schemes and compulsory social health insurance covering various groups of state employees.

HP.6.3 Other social insurance. The funding and administration of social health insurance (other than government-provided compulsory social security programmes): the administration of private social health insurance and sickness funds; the administration of complementary social insurance (mutuality); the administration of employers' social health insurance programmes (other than government social security and government health programmes for state employees).

HP.6.4 Other (private) insurance. Health insurance (other than by social security funds or other social insurance), including establishments primarily engaged in activities involved in, or closely related to, the management of insurance.

HP.6.9 All other providers of health administration.

Private establishments primarily engaged in providing health administration (other than private social insurance and other private insurance).

HP.7 Other industries (rest of the economy).

Industries not elsewhere classified which provide health care as secondary producers or other producers: occupational health care, home care provided by private households, military and prison health services (not provided in separate healthcare establishments) or school health services.

HP.7.1 Establishments as providers of occupational healthcare services.

Establishments providing occupational health care as ancillary production.

HP.7.2 Private households as providers of home care.

Private households as providers of home care.

HP7.9 All other industries as secondary producers of health care.

Military and prison health services not provided in separate healthcare establishments; school health services.

HP.9 Rest of the world. All non-resident units providing health care for final use by resident units.



AANNNNEEXXEE 66:: IICCHHAA--HHFF –– CCLLAASSSSIIFFIICCAATTIIOONN OOFF HHEEAALLTTHHCCAARREE FFIINNAANNCCIINNGG AAGGEENNTTSS

ICHA-HF Sources of healthcare funding SEC-95

HF.1 General government (S.13). – The general government sector, including all institutional units that are non-market producers whose production is intended for individual and collective consumption, mainly financed by compulsory payments made by units from other sectors and all institutional units primarily involved in the redistribution of national revenue and wealth. The institutional units classified in this sector are as follows: a) general government institutional units (excluding public producers organised as venture capital or, under special legislation, endowed with independent legal status, or as quasi-corporate enterprises if classified under the financial or non-financial sectors) which manage and fund a range of activities destined for collective consumption– mainly the supply of non-market items and services; b) non-profit institutions with independent legal status acting as other non-market producers, controlled and financed mainly by the government; c) autonomous pension funds (compulsory social security or social insurance funds managed by the government). The general government sector can be divided into four sub-sectors: central government, state/provincial, local and social security funds.

S.13

HF.1.1 General government, excluding social security funds (S.1311, S.1312 and S.1313). – Includes the sub-sectors of central (S.1311), state (S.1312) and local (S.1313) government. The central government sub-sector (S.1311) includes all the administrative organs of the state and other central institutional units whose powers normally extend to the whole of the economic territory, with the exception of social security funds. This sub-sector also covers non-profit organisations mainly controlled and financed by the government whose powers extend to the whole of the economic territory. The state/provincial government sub-sector (S.1312) consists of administrations which are separate institutional units and exercise certain government functions at a level below that of the central government and above that of the local state institutional units, excepting the administration of social security funds. This sub-sector includes non-profit organisations controlled and financed mainly by the state/provincial sub-sector whose powers are restricted to the state/provincial economic territory. The local government sub-sector (S.1313) comprises all administrations whose powers cover only a part of the economic territory, except for services relating to local social security funds. This sub-sector also includes non-profit institutional units mainly controlled and financed by local governments whose powers are restricted to the economic territory of these administrations.

S.1311, S.1312 e S.1313

HF.1.2 Social security funds (S.1314). – The social security funds sub-sector includes all central institutional units, both state/provincial and local, whose main activity consists of granting welfare benefits and which meet the following criteria: a) certain groups in the population are obliged by legal provisions or regulations to participate in the scheme or to pay contributions; b) independently of the role they play as governing bodies or employers, governments are responsible for managing these units in relation to setting or approving contributions and payments (there being normally no direct link between the amount of contributions paid by an individual and the risks to which they are exposed).

S.1314



HF.2 Private sector (S.125, S.14 and S.15). – This sector comprises all resident institutional units that do not belong to the government sector. To classify the sources of funding for health care, four sub-sectors should be distinguished: a) private social insurance (S.125); b) private insurance enterprises (other than social insurance) (S.125); c) private household out-of-pocket expenditure (S.14); d) NPISHs and societies (other than social insurance) (S.15).

S.125, S.14 e S.15

HF.2.1 Private social insurance (S.125). – This sector comprises all social insurance funds in health (other than social security funds). It includes programmes set up by the government for their employees only.

S.125

HF.2.2 Private insurance enterprises (other than social insurance) (S.125). – This sector comprises all private insurance enterprises (other than social insurance). It includes both profit and not-for-profit insurance schemes, except for social insurance.

S.125

HF.2.3 Private household out-of-pocket expenditure (S.14). – private household expenditure on health care, after taking contributions (social security, health insurance) into account, i.e. costs which cannot be further distributed (expenses which remain household expenses as a whole).1

S.14

HF.2.4 NPISHs (other than social insurance) (S.15)1. – Private institutions providing goods or services to households free of charge or at prices that are not economically significant. They include private philanthropic organisations that supply goods and services on a non-market basis to households in need, including those worst affected by natural disasters and war. They are financed by governments, corporations and individuals, including transfers from non-resident entities (in the case of the latter, essentially national agencies belonging to international humanitarian organisations based abroad).

S.15

HF.2.5 Corporations (other than health insurance) (S.15). – Includes all corporations and quasi-corporations whose principal activity is the production of market goods and services (other than health insurance). Includes all resident non-profit institutions that are market producers of goods or non-financial services.

S.15

HF.3 Rest of the world (S.2). – Includes non-resident institutional units or those that reside abroad.

S.2

1 This indicator is difficult to access and requires specific statistical support (S.14). 1 When these institutions are of little significance, they are not considered in this sector; their operations are included in those of households (S.14).



AANNNNEEXXEE 77:: IICCHHAA--HHCC –– CCLLAASSSSIIFFIICCAATTIIOONN OOFF HHEEAALLTTHHCCAARREE FFUUNNCCTTIIOONNSS

ICHA-HC Functions of health care HC.1 Services of curative [and diagnostic]. HC.1.1 In-patient curative care. HC.1.2 Day cases of curative care. HC.1.3 Out-patient curative [and diagnostic] care.

HC.1.3.1 Basic medical and diagnostic services. HC.1.3.2 Out-patient dental care. HC.1.3.3 All other specialised [curative] health care. HC.1.3.9 All other out-patient curative care. HC.1.4 Services of curative [and diagnostic] home care. HC.2 Services of rehabilitative care. HC.2.1 In-patient rehabilitative care. HC.2.2 Day cases of rehabilitative care. HC.2.3 Out-patient rehabilitative care. HC.2.4 Services of rehabilitative home care. HC.3 Services of long-term nursing care. HC.3.1 In-patient long-term nursing care. HC.3.2 Day cases of long-term nursing care. HC.3.3 Long-term nursing care: home care. HC.4 Ancillary services to health care: clinical laboratories, diagnostic imaging, patient transport

and emergency rescue. HC.4.1 Clinical laboratories. HC.4.2 Diagnostic imaging. HC.4.3 Patient transport and emergency rescue. HC.4.9 All other miscellaneous ancillary services to health care. HC.5 Medical goods dispensed to out-patients. HC.5.1 Pharmaceuticals and other medical non-durables. HC.5.1.1 Prescribed medicines. HC.5.1.2 Over-the-counter medicines. HC.5.1.3 Other medical non-durables. HC.5.2 Therapeutic appliances and other medical durables. HC.5.2.1 Glasses and other vision products. HC.5.2.2 Orthopaedic appliances and other prosthetics. HC.5.2.3 Hearing aids. HC.5.2.4 Medico-technical devices, including wheelchairs. HC.5.2.9 All other miscellaneous medical durables. HC.6 Prevention and public health services. HC.6.1 Maternal and child health, family planning and counselling. HC.6.2 School health services. HC.6.3 Prevention of communicable diseases. HC.6.4 Prevention of non-communicable diseases. HC.6.5 Occupational health care. HC.6.9 All other miscellaneous public health services. HC.7 Health administration and health insurance. HC.7.1 General government administration of health and compulsory social security. HC.7.1.1 General government administration of health (except compulsory social security). HC.7.1.2 Administration, operation and support activities of social security funds. HC.7.2 Health administration and health insurance: private. HC.7.2.1 Health administration and health insurance: social insurance. HC.7.2.2 Health administration and health insurance: other private.



Classification of health-care related functions:

ICHA-HC Health-related functions HC.R.1 Capital formation of healthcare provider institutions. HC.R.2 Education and training of health personnel. HC.R.3 Research and development (R & D) in health. HC.R.4 Food, hygiene and drinking water control. HC.R.5 Environmental health. HC.R.6 Administration and provision of social services in kind to assist living with disease and

impairment. HC.R.7 Administration and provision of health-related cash benefits.



AANNNNEEXXEE 88:: SSNNAAPP ((BBAASSEE 9955)) IINNSSTTIITTUUTTIIOONNAALL SSEECCTTOORR NNOOMMEENNCCLLAATTUURREE

S1 TOTAL ECONOMY S11 NON-FINANCIAL CORPORATIONS

S11001 Public non-financial corporations S110011 Public non-financial corporations whose shares are mostly state-owned S110012 Public non-financial quasi-corporations S11002 National private non-financial corporations S11003 Foreign-controlled non-financial corporations

S12 FINANCIAL CORPORATIONS

S121 Central bank S122 Other depository corporations S12201 Public S12202 National private S12203 Foreign-controlled S123 Other financial intermediaries, except insurance corporations and pension funds S12301 Public S12302 National private S12303 Foreign-controlled S124 Financial auxiliaries S12401 Public S12402 National private S12403 Foreign-controlled S125 Insurance corporations and pension funds S1251 Insurance corporations S12501 Public S12502 National private S12503 Foreign-controlled S1252 Pension funds (autonomous)

S13 GENERAL GOVERNMENT

S1311 Central government S13111 State S13112 Central government autonomous services and funds S13113 Central government non-profit institutions S1313 Regional and local government S13131 Regional government S131311 Organs of regional government S131312 Regional government autonomous services and funds S131313 Regional government non-profit institutions S13132 Local government S131321 Districts S131322 Municipalities S131323 Parishes S131324 Local government autonomous services and funds S131325 Local government non-profit institutions S1314 Social security funds

S14 HOUSEHOLDS

S15 NON-PROFIT INSTITUTIONS SERVING HOUSEHOLDS

S2 REST OF THE WORLD S21 EUROPEAN UNION

S211 EU member states S2111 Monetary Union member countries S2112 Monetary Union non-member countries S212 EU institutions

S22 OTHER COUNTRIES AND INTERNATIONAL ORGANISATIONS



AANNNNEEXXEE 99:: CCLLAASSSSIIFFIICCAATTIIOONN OOFF IINNDDIIVVIIDDUUAALL CCOONNSSUUMMPPTTIIOONN BBYY PPUURRPPOOSSEE ((CCOOIICCOOPP))

Code Designation 01 Food and non-alcoholic beverages 01.1 Food 01.2 Non-alcoholic beverages 02 Alcoholic beverages, tobacco and narcotics 02.1 Alcoholic beverages 02.2 Tobacco 02.3 Narcotics 03 Clothing and footwear 03.1 Clothing (including repair, hire and clothing materials) 03.2 Footwear (including accessories, repair and hire) 04 Housing, water, electricity, gas and other fuels 04.1 Actual rentals for housing 04.2 Imputed rentals for housing 04.3 Maintenance and repair of the dwelling 04.4 Water supply and miscellaneous services relating to the dwelling 04.5 Electricity, gas and other fuels 05 Furnishings, household equipment and routine household maintenance 05.1 Furniture and furnishings, carpets and other floor coverings 05.2 Household textiles and their repair 05.3 Household appliances and their repair 05.4 Glassware, tableware and household utensils and their repair 05.5 Tools and equipment for house and garden 05.6 Goods and services for routine household maintenance 06 Health 06.1 Pharmaceutical products, appliances and therapeutic equipment 06.2 Out-patient services 06.3 Hospital services 07 Transport 07.1 Purchase of vehicles 07.2 Operation of personal transport equipment 07.3 Transport services 08 Communication 08.1 Postal services 08.2 Purchase and repair of telecommunications equipment 08.3 Telecommunications services 09 Leisure, recreation and culture 09.1 Purchase and repair of audio-visual, photographic and information processing equipment and

accessories 09.2 Other major durables for leisure, recreation and culture 09.3 Other leisure and recreational items and equipment; plants, flowers and other garden equipment,

pets and related services 09.4 Sports, recreational and cultural services 09.5 Newspapers, books and stationery 09.6 Package holidays 10 Education 10.1 Pre-primary and primary education (1st cycle) 10.2 Secondary education (2nd and 3rd cycles) 10.3 Secondary education (2nd and 3rd cycles) + post-secondary non-tertiary education 10.4 Tertiary education 10.5 Education not definable by level 11 Restaurants, hotels, cafés and similar (including catering) 11.1 Catering services 11.2 Accommodation services 12 Miscellaneous goods and services 12.1 Personal care 12.2 Prostitution 12.3 Personal effects n.e.c. 12.4 Social protection 12.5 Insurance 12.6 Financial services n.e.c. 12.7 Other services n.e.c. 13 Individual consumption expenditure of NPISHs 14 Individual consumption expenditure of general government



AANNNNEEXXEE 1100:: CCLLAASSSSIIFFIICCAATTIIOONN OOFF FFUUNNCCTTIIOONNSS OOFF GGOOVVEERRNNMMEENNTT ((CCOOFFOOGG)) CODE DESIGNATION

01 General public services

01 01 Executive and legislative organs, financial and fiscal affairs, external affairs 01 02 Foreign economic aid 01 03 General services 01 04 Basic research 01 05 R&D General public services 01 06 General public services n.e.c. 01 07 Public debt transactions 01 08 Transfers of a general character between different levels of government

02 Defence

02 01 Military defence 02 02 Civil defence 02 03 Foreign military aid 02 04 R&D Defence 02 05 Defence n.e.c.

03 Public order and safety

03 01 Police services 03 02 Fire-protection services 03 03 Law courts 03 04 Prisons 03 05 R&D Public order and safety 03 06 Public order and safety n.e.c.

04 Economic affairs

04 01 General economic, commercial and labour affairs 04 02 Agriculture, forestry, fishing and hunting 04 03 Fuel and energy 04 04 Mining, manufacturing and construction 04 05 Transport 04 06 Communication 04 07 Other industries 04 08 R&D Economic affairs 04 09 Economic affairs n.e.c.

05 Environmental protection

05 01 Waste management 05 02 Waste water management 05 03 Pollution abatement 05 04 Protection of biodiversity and landscape 05 05 R&D Environmental protection 05 06 Environmental protection n.e.c.

06 Housing and community amenities

06 01 Housing development 06 02 Community development 06 03 Water supply



06 04 Street lighting 06 05 R&D Housing and community amenities 06 06 Housing and community amenities n.e.c.

07 Health

07 01 Medical products, appliances and equipment 07 02 Outpatient services 07 03 Hospital services 07 04 Public health services 07 05 R&D Health 07 06 Health n.e.c.

08 Recreation, culture and religion

08 01 Recreational and sporting services 08 02 Cultural services 08 03 Broadcasting and publishing services 08 04 Religious and other community services 08 05 R&D Recreation, culture and religion 08 06 Recreation, culture and religion n.e.c.

09 Education

09 01 Pre-primary and primary education 09 02 Secondary education 09 03 Post-secondary non-tertiary education 09 04 Tertiary education 09 05 Education not definable by level 09 06 Subsidiary services to education 09 07 R&D Education 09 08 Education n.e.c.

10 Social protection

10 01 Sickness and disability 10 02 Old age 10 03 Survivors 10 04 Family and children 10 05 Unemployment 10 06 Housing 10 07 Social exclusion n.e.c. 10 08 R&D Social protection 10 09 Social protection n.e.c

88 Without functional classification



AANNNNEEXXEE 1111:: HHEEAALLTTHHCCAARREE EEXXPPEENNDDIITTUURREE BBYY SSOOUURRCCEE OOFF FFUUNNDDIINNGG

Sources of funding SNA Institutional sectors

Public funding Private funding SNA 93 Code Designation Details

S.1311 S.1313 S.1314 S.125 S.125 S.14 S.11 S.15

D.51

Taxes on income

Taxes on income applied to individuals/households (including taxes deducted at source by employers and on the revenue of non-corporation enterprises) + surtaxes

X

X

D.63

Social transfers in kind

Goods and services provided as transfers in kind to

households by government units (including social security funds) and NPISHs, whether purchased on the market or produced as non-market output by the units making these

payments.

Social transfers in kind designed to reduce costs for those at risk or in need (EAS95 §4.84).

There are two categories: Beneficiaries acquire goods and services directly from market units and are then reimbursed;

D.631

Welfare benefits in kind

The services in question are supplied directly to beneficiaries by market producers operating under agreements and conventions. In this case, the government and the NPISHs totally or partially bear the costs of the goods and services purchased by households and supplied by the market units and the beneficiaries bear part or none of the cost of purchasing the goods or services.

D.6311

Social security benefits, reimbursements

The reimbursement from social security funds of approved expenditure made by households on specified goods and services.

X X X X



D.6312

These constitute social transfers in kind, except for reimbursements paid by social security funds to households.

Other social security benefits in kind

E.g. medical or dental treatment, surgery, in-patient hospital care, glasses or contact lenses, medical equipment and other goods and services supplied to those at risk or in need.

D.6313

Transfers in kind provided to households by government units or NPISHs outside the context of social insurance.

Social assistance benefits in kind

E.g.: If not covered by social security schemes, council housing, housing allowances, day care, professional training, subsidised travel (if for social purposes) and other similar goods and services within the context of risk and need. Goods and services provided free of charge or at prices that that are not economically significant by government units or NPISHs. Corresponding to : Expenditure on individual consumption by governments and NPISHs – D.631 (Welfare benefits in kind).

D.632

Transfers of individual non-market goods and services

In relation to governments:

D.632 (Transfers of individual non-market goods and services) is accounted for on the basis of the COFOG (EAS95 §3.85). §3.85 establishes, by agreement, the COFOG (Classification of the Functions of Governments), the distinction between individual and collective goods and services.

By agreement, all government expenditure on final consumption must be treated as individual unless, within each category, it relates to expenditure on general government, regulation and research.



I In relation to NPISHs, all expenditure incurred by these units is regarded, by agreement as individual.

P.42

Collective services supplied simultaneously to all members of the community, namely:

- general healthcare administration;

- management and regulation;

- Maintenance of public health;

Actual collective final consumption - Research and development

X X X

D.62

Social benefits other than social transfers in kind

D.621

Social benefits paid in cash from social security funds for:

Sickness and invalidity;

Maternity, child or family allowance, allowances for other dependents;

Unemployment benefits;

Retirement and survivors pensions;

Death benefits;

Social security benefits in cash

Other allowances or benefits. D.622

Private funded social benefits

Social benefits paid to households by insurance enterprises or other institutional units administering private funded social insurance. There is no distinction between cash payments and payments in kind, since private funded benefits cannot be in kind.

D.623

Unfunded employee social benefits

Social benefits paid to employees and their dependents by employers administering unfunded social insurance. They include, for example:

X X X X X



Payment of full or reduced salaries during periods of sick leave, maternity leave, etc.;

Payment of family allowances, education grants and other to dependents;

Payment of retirement or survivors pensions to ex-employees;

General medical services not related to the employee’s work;

Homes for the elderly and convalescent homes. D.624

Social assistance benefits in cash

Benefits paid to households by government units or NPISHs to meet the same needs as social insurance benefits but which are not made under a social insurance programme incorporating social contributions and social insurance benefits.

D.31

Subsidies

Subsidies paid by governments to healthcare providers to balance the price of production, excluding social benefits in kind.

D.311 and D.312 – subsidies on imports/exports (not considered under health care);

X

D.75

Miscellaneous current transfers

Includes: current transfers to NPISHs = cash transfers received on a regular or occasional basis from other resident or non-resident units in the form of membership dues, subscriptions, voluntary donations and transfers in kind (donations of food, clothing, blankets, medicines, etc.).

X X X



D.72

Non-life insurance claims

Non-life insurance claims paid on policies held by employers to individual households = current premiums paid by policy holders for insurance coverage during the accounting period and supplements on premiums to be paid with the property income attributed to holders of insurance premiums.

X

P.41

Actual individual final consumption

Household expenditure on healthcare goods and services = out-of-pocket payments

X X

P.41*

Occupational health care

Estimate of occupational health care supplied by providers and other industries.

X



AANNNNEEXXEE 1122:: DDEECCIISSIIOONN--MMAAKKIINNGG AALLGGOORRIITTHHMM:: DDIISSTTIINNCCTTIIOONN BBEETTWWEEEENN MMAARRKKEETT PPRROODDUUCCEERRSS,, PPRROODDUUCCEERRSS FFOORR OOWWNN FFIINNAALL UUSSEE AANNDD NNOONN--MMAARRKKEETT PPRROODDUUCCEERRSS IINN RREELLAATTIIOONN TTOO IINNSSTTIITTUUTTIIOONNAALL UUNNIITTSS

Type of Institutional Unit Classification

Private or public? NPI or not?

Do sales cover + than 50% of

production costs?

Type of producer Sectors

1.1 – Non-corporate enterprises owned by households (excluding quasi-corporations owned by households)

1.1 = Market or for own final use

Households (S.14)

1 – Private producers

1.2 – Other private producers (including quasi- corporations owned by households)

1.2.1 – Private NPIs

1.2.2 – Other private

producers (not NPIs)

1.2.1.1 - Yes 1.2.1.2 - No

1.2.1.1 = Market 1.2.1.2 = Non-market 1.2.2 = Market

Corporations (S.11 or S.12) NPISHs (S.15) Corporations (S.11 or S.12 )

2 – Public producers

2.1 - Yes 2.2 - No

2.1= Market 2.2= Non-market

Corporations (S.11 or S.12) Government (S.13)



AANNNNEEXXEE 1133:: CCOOMMPPAARRIISSOONN OOFF BBUUSSIINNEESSSS AACCCCOOUUNNTTSS AANNDD AADDMMIINNIISSTTRRAATTIIVVEE DDAATTAA WWIITTHH EESSAA9955 NNAATTIIOONNAALL AACCCCOOUUNNTTSS CCOONNCCEEPPTTSS - APROPRIATION OF SBS DATA – STRUCTURAL BUSINESS SU RVEY (F2)

POC

Account

SBS

Items Definition POC concept EAS95

classification - Q20001 Total employees –

average number of employees

- NPS

- Q20201 Paid employees – average number of employees

- NPSR

422 Q70914/5/6

Buildings and other constructions

Only registers buildings and other constructions used in company operations.

P51

423 Q71014/5/6

Basic equipment All instruments, machines, installations and other goods used in company activities.

P51

424 Q71114/5/6

Transport equipment Registers fixed assets relating to transport, loading and unloading.

P51

425 Q71214/5/6

Tools and utensils Registers tools and utensils with a useful life of over one year.

P51

426 Q71314/5/6

Office equipment Includes social equipment and miscellaneous furniture and fittings.

P51



POC

account

SBS items Definition POC concept EAS95

classification

427+ 429 Q71414/5/6

Consignable packaging and other tangible fixed assets

427 – Comprises objects that will contain or be added to the goods or products, whether for use within the establishment only or as returnable packaging that can be re-used. 429 – Registers all goods not included in the sub-sections of account 42.

P51

441/6 Q71514/5/6

Fixed assets under construction

Covers fixed assets that will supplement, improve or replace existing assets, for which procedures are still in progress.

P51

61 Q4000 Cost of goods sold and materials consumed

-P1 / P2

- Q4010 Cost of goods sold Registers the movement of stock from the warehouse for sale.

-P1

- Q4020 Cost of materials consumed

Registers the movement of stock from the warehouse for use in production.

P2

62 Q5000 Supplies and external services

P2 / D71

621 Q5010 Subcontractors Comprises work that is part of the productive process and requires the cooperation of other companies.

P2

622 Q5020 Supplies and services Registers costs paid, or to be paid, to third parties, either for services provided to the company or for supplies for the company.

P2 / D71

62211 Q5030 Electricity Corresponds to expenditure on electrical energy.

P2

62212 Q5040 Fuel Registers fuel costs. P2 62213 Q5050 Water Registers the cost of water

consumed. P2

62219 Q5060 Rents and rentals, comprising:

Refers to the rental of land and buildings and equipment hire.

P2

- Q5070 Rental of land D45 - Q5080 Operational long-term

rental or leasing P2



POC

account SBS items Definition POC concept EAS95

classification

62221 Q5090 Promotion expenses Registers expenditure on promotion of the company.

P2

62222 Q5100 Communications Registers all expenditure on communications, such as stamps, postal charges, telephones, etc.

P2

62223 Q5110 Insurance Insurance which is the responsibility of the company, except when related to employee costs.

P2 / D71

62224 Q5120 Royalties Registers royalties such as patent rights, licences, models, brands names, etc.

P2

62225 Q5130 Transport of goods Registers company expenditure on the transport of products sold and the transport of non-warehoused purchased goods. Costs relating to warehoused goods should be referred to the Purchases account.

P2

62226 Q5140 Transport of employees Includes long-term transport costs for delivering employees to and from the workplace.

P2

62227 Q5150 Business trips Comprises the cost of accommodation and food outside the workplace (not supported by a subsistence allowance) and the cost of transporting personnel on a temporary basis.

P2

62229 Q5160 Fees Comprises payments made to self-employed workers.

P2

62231 Q5170 Legal expenses Registers current expenses on law courts, notary offices, civil and commercial registrar's offices etc. Does not cover fines and penalties.

P2

62232 Q5180 Maintenance and repairs

Includes goods and services pertaining to the maintenance of fixed assets which do not lead to an increase in their cost or useful life.

P2



POC


classification 62233 Q5190 Advertising and

promotion Registers purchase of materials, as well as expenditure on services for publicising or advertising the company.

P2

62234 Q5200 Cleaning and hygiene Registers purchases of materials and services provided to the company for the purposes of cleaning, hygiene and comfort.

P2

62235 Q5210 Security Registers purchases of materials and services provided to the company for security and surveillance purposes.

P2

641 Q6010 Payments to directors Registers all payments to the owner or directors.

D112

642 Q6020 Staff wages and salaries

Includes all net wages and salaries and additional payments to staff.

D11

643 Q6030 Pensions Registers payments relating to pensions, including retirement and invalidity pensions, when responsibility for payment has not been transferred to an external body.

D122

644 Q6040 Pension premiums Refers to premiums paid to external bodies when these are used to support the cost of pensions payments.

D121

645 Q6050 Charges on remunerations

Registers the company's social security contributions.

D121

646 Q6060 Work and occupational illness insurance

Includes insurance premiums for work-related accidents and occupational illnesses paid to insurance companies.

D121

647 Q6070 Employees benefit costs

Registers the costs of social actions which benefit the company staff and their households.

D11 / D122

2 Subsistence allowances in this account may be classified as D11 or P2.



POC


classification 648 Q6080 Other employee costs Registers all staff costs not

covered by other sub-accounts.

P2

65 Q4100 Miscellaneous operating expenses

Registers costs not related to the main objectives of the company but still considered operational costs.

P2

681 Q11000 Interest payable Registers interest payable on operations indicated in sub-accounts.

D41

6811 Q11010 Comprising: bank loans

Registers interest on bank loans.

D41

682/4 Q11020 682 – Losses in group and associated companies 683 – Fixed assets investment depreciation 684 – Provisions for financial investments

Represents the corresponding negative amount belonging to the company within the own capital of a group company. Covers the depreciation of fixed assets acquired in order to generate income. Registers the positive estimated value of financial investment risks.

Not considered an operation, unless external. Different concept. Not considered an operation.

685 Q11030 Exchange losses Registers losses realised on exchange rates pertaining to the company's current activity and to the financing of fixed asset accounts.

-K11

686 Q11040 Discounts allowed Registers discounts, whether invoiced or applied at a later date.

-P10

687 Q11050 Losses from the sale of financial investments

Includes losses, i.e. the difference between the cost of bills of exchange sold and product sold.

K11

688/9 Q11060 Other financial costs Registers all financial expenses not entered in previous accounts.

P2



POC


classification 691 and

695 Q12000 691 – Donations

695 – Fines and penalties

Registers donations to the company from third parties. Classifies charges resulting from penalties incurred by the company as a result of infractions of the law and from legally binding contracts.

D75

692 Q12010 Losses on irrecoverable debts

Registers losses resulting from irrecoverable third party debts.

-K10

6941 Q12020 Sale of financial investments

Registers losses resulting from the sale of financial assets.

-K2 (land), -K11

6942 + 6944/8

Q12030 6942 – Sale of tangible fixed assets 6944 – Accidents 6945 – Reductions 6948 – Other

Registers losses resulting from the sale of tangible fixed assets or from accidents and reductions.

-K11

-K9

-K9

-K9 6943 Q12040 Sale of intangible fixed

assets Registers losses resulting from the sale of intangible fixed assets.

-K11

693 + 696/9

Q12050 693 – Stock losses 696 – Increase in depreciation rates and provisions 697 – Adjustments to previous years 698 – Other extraordinary expenses

Registers losses originating from accidents, unusual spillage and other situations relating to stock. Registers increased depreciation and extraordinary provisions relating to adjustments to fixed-asset and third-party accounts. Comprises slight adjustments made to previous financial years. Register extraordinary losses not covered by other sub-accounts of account 69.

K9

Different concept

K9/K10

D51/K9/K10/K11



POC


classification 71 Q4160 Sales P1 - Q4170 Goods for resale Registers the sales value of

goods purchased externally for the purpose of sales.

P1

- Q4180 Sales of finished and semi-finished goods

Registers the sale of products resulting from the processing of raw materials or diverse materials.

P1

72 Q4190 Provision of services Registers services provided which constitute the purpose or objective of the company's business.

P1

- Q4200 Changes in production - P1 - Q100001/

2/3 Closing inventory -

- Q100101/2/3

Stock adjustments -

- Q100201/2/3

Initial stock -

- Q100301/2/3

Changes in production -

73 Q4220 Supplementary income Registers income from the added value of activities pertaining to the company's business.

P1

75 Q4210 Capitalisation of own costs

Registers the value of work carried out by the company for itself, using its own resources or those acquired for the purpose, to be included in its fixed assets.

P12

74 Q4240 Subsidies Refers to funds paid to the company with the aim of reducing costs or increasing revenue.

D3

76 Q4250 Other operating income Registers income, other than added value, from activities that do not constitute part of the company's main business.

781 Q11080 Interest earned Comprising: bank deposits

Registers interest earned. D41

782 Q11100 Gains from group and associate companies

Represents the corresponding positive amount belonging to the company within the own capital of a group company.

---



783 Q11110 Income from real estate Register financial returns, rent and other income derived from investments in property.

P1

POC


classification 784 Q11130 Dividends Registers income from

capital investments in other companies.

D42

785 Q11150 Exchange gains Includes exchange gains related to current company activity and to the financing of fixed asset accounts.

K11

786 Q11160 Discounts obtained Registers discounts, whether invoiced or applied at a later date.

-P20

787/8 Q11170 787 – Income from the sale of financial investments 788 – Other financial income

Registers gains from the sale of marketable securities and other financial investments. Registers income and financial gains not elsewhere classified.

K11

791+ 795 Q12070 791 – Tax refunds 795 – Profits from contract penalties

Registers company tax refunds from the state resulting from over-payment of taxes. Registers gains resulting from penalties imposed by the company on clients or other entities.

792 Q12080 Recovery of debts Registers any amount credited to the company that was previously considered irrecoverable and placed under account 692 - losses on irrecoverable debts.

K10



POC


classification 793+ 796/7

Q12090 793 – Gains in stock 796 – Reduction in depreciation rates and provisions 797 – Adjustments to previous years

Registers gains from stock not derived from purchases, sales or consumption. Registers reductions in depreciation rates and essential provisions at the end of the financial year. Registers income which, due to error, was not accounted for in the previous financial year, or knowledge of facts and amounts relating to previous financial years, which would have been impossible to obtain before the current financial year.

K9

Different concept

K9/K10

7941 Q12100 Sale of financial investments

Registers gains from the sale of financial investments.

K2,K11

7943 Q12110 Sale of intangible fixed assets

Registers gains from the sale of intangible fixed assets.

K11

7942+7944/8

Q12120 7942 – Sale of tangible fixed assets 7944 – Accidents 7948 – Other

Registers gains from the sale of tangible fixed assets.

K11

K9

K9 7983 Q12130 Investment subsidies Registers the annual value of

depreciation on subsidised assets.

Different concept

7981+7982

Q12140 7981 – Overestimated tax provisions 7982 – Extraordinary exchange gains

Registers overestimates of tax payable on revenue from the previous year. Registers gains from favourable exchange rates resulting from exceptional circumstances.

K11

K9/K10



Algorithms used in calculations:

SBS Model A (sent to companies with NPS (No. of employees) ≥ 20):

P111 – Sales of goods = Q4170*(1-WF.1)

P112 – Production of goods =(Q4160-Q4170)*(1-WF.1)+Q4200

P113 – Production of services = Q4190*(1-WF.1)

P114 – Production of other services =Q4220+Q4250+Q11110-Q11120 P1142 – Rental of premises =Q11110-Q11120

P12 – Production for own final use =(Q70914+Q71014+Q71114+Q71214+Q71314+Q71414

+Q71514)

P21 – Cost of goods = Q4010*(1-WF.2)

P22 – Material consumption = (Q4000-Q4010)*(1-WF.2)

P23 – Consumption of services = Q4030*(1-WF.2)-Q5070-Q5110

P24 – Consumption of other services = Q4100+Calc1

If other than owner: NPS – No. of employees = Q20001 NPSR – No. of paid employees = Q20201 D11 = Q6010+Q6020 D121 = Q6040+Q6050+Q6060 D122 = Q6030 RMIST =Q6070+Q6080-Calc1-Calc2

If owner: NPS – No. of employees =Q20001 NPSR – No. of paid employees = Q20201 D11 = Q6020 D121 = (Q6040+Q6050+Q6060)-

(Q6010*Q6050/(Q6010+Q6020)) D122 = Q6030 RMIST =Q6070+Q6080-Calc1-Calc2

Mc – Trade margin = P111 – P21 P1 – Production =Mc + P112 + P113 + P114 + P12 P2 – Intermediate consumption = P22 + P23 + P24 VAB = P1 - P2

SBS Model A (sent to companies with NPS ≥ 20):

Weighting factors (WF) / Calculations: WF.1 – Discounts allowed = A/B A = Q11040



B= Q4160 + Q4190

WF.2 – Discounts obtained = C/D C = Q11160 D= Q4000 + Q4030

Calc1 – Vocational training services E = 0.008*Q6000 F = Q6070+Q6080 Se (Q6070+Q6080) = 0 Calc1 = 0 Se E>F Calc1 = F Se E<F Calc1 = E

Calc2 – Staff recruitment and uniforms G = 0.044*Q6000 H = Q6070+Q6080-Calc1 Se H = 0 Calc2 = 0 Se G>H Calc2 = H Se G<H Calc2 = G Model B (sent to companies with NPS < 20):

SE CAE = Trade P111B – Sale of goods =Q4160 + Q4200

SE CAE >< Trade

P112B – Production of goods = Q4160 + Q4200

P113B- Production of services =Q4190

SE CAE = Trade P21B – Cost of goods =Q4000

SE CAE >< Trade

P22B – Material consumption =Q4000

P23B – Consumption of services =Q4030

If other than owner: NPSB - No. of employees Q2000 NPSRB - No. of paid employees Q2020 D11B Q6010+Q6020 D121B Q6065 RMISTB Q6085

Model B (sent to companies with NPS < 20):

If owner: NPSB – No. of employees Q2000 NPSRB - No. of paid employees Q2020 D11B Q6020 D121B Q6065-(Q6010*Q6065/(Q6010+Q6020)) RMISTB Q6085



McB – Trade margin =P111 - P21 P1B – Production =Mc + P112 + P113 P2B – Intermediate consumption =P22 + P23 VABB =P1 - P2



AANNNNEEXXEE 1144:: DDLL 444422--AA//8888 LLIISSTT ((IIRRSS OORRIIGGIINNAALL)) Classification of Economic Activity 2 Architects, engineers and other similar technicians: 2.1 Architects; 2.2 Qualified builders; 2.3 Engineers; 2.4 Technical engineers; 2.5 Topographers; 2.6 Draughtsmen; 2.7 Geologists; 3 Plastic artists or similar, actors, musicians, journalists and reporters: 3.1 Painters; 3.2 Sculptors; 3.3 Decorators; 3.4 Other plastic artists; 3.5 Theatre, dance, cinema, radio and television artists; 3.6 Circus artists; 3.7 Musicians; 3.8 Journalists and reporters; 4 Bullfighting professionals: 4.1 Bullfighters and other bullfighting professionals; 5 Economists, accountants, actuaries and similar: 5.1 Economists and tax consultants; 5.2 Accountants, accounts technicians and book-keepers; 5.3 Actuaries. 6 Nurses, midwives and other licensed paramedics: 6.1 Nurses; 6.2 Nutritionists; 6.3 Midwives; 6.4 Other paramedics. 7 Members of the legal profession: 7.1 Jurists; 7.2 Barristers; 7.3 Solicitors. 8 Doctors and dentists: 8.1 Medical analysts; 8.2 General practitioners; 8.3 Surgeons; 8.4 Stomatologists; 8.5 Physiatrists; 8.6 Gastroenterologists; 8.7 Ophthalmologists; 8.8 Othorhinolaryngologists; 8.9 Radiologists; 8.10 Other specialist doctors; 8.11 Ship's doctors;



8.12 Dental surgeons; 8.13 Dentists. 10 Officially appointed professionals: 10.1 Statutory auditors. 11 Psychologists and sociologists: 11.1 Psychologists; 11.2 Sociologists. 12 Chemists: 12.1 Analysts. 13 Members of the clergy: 13.1 Religious officials from any faith. 14 Veterinary surgeons: 14.1 Veterinary surgeons. 15 Other members of liberal professions, technicians and similar: 15.1 Systems analysts and computer programmers; 15.2 Publishers of own works; 15.3 Expert assessors; 15.4 Astrologers and parapsychologists; 15.5 Sportsmen/women.



ANNEXE 15: ALGORITHMS USED TO CALCULATE EXPENDITURE ON HEALTH CARE BY PROVIDER INDUSTRY

Institutional sectors

HP. Calculation perspective Non-financial corporations General government Sole proprietors and the self-

employed NPISHS

Production = Expenditure Method of estimation: Method of estimation: Method of estimation:

Production = Estimates of production of statistical units classified in National Accounts, by institutional sector (corporations, general government and NPISHs)

Market production = ∑ Sales= trade margins + production of goods + provision of services

Non-market production= ∑ Production costs = CMC + FSE + salaries + other operational costs + consumption of fixed capital

Market production = ∑ Sales= trade margins+ production of goods + provision of services

Non-market production = ∑ Production costs = CMC + FSE + salaries + other operating costs + consumption of fixed capital

Sources of information: Sources of information: Sources of information:

- SBS; - IGIF; - Survey of IPSSs;

- PT–ACS report and financial statement (private social insurance subsystem).

- Other reports and financial statements.

- Annual survey of Mutual Aid societies;

Reports and financial statements and detailed cost accounting of Hospitals-Enterprise.

Regional Health Services of Azores and Madeira

- SAMS report and financial statement (private social insurance subsystem).

HP.1 - Hospitals

Reports and financial statement

HP.2 - Nursing and residential care

Production = Expenditure Method of estimation: Method of estimation: Method of estimation:



Production = Production estimates for corporations + sole proprietors and the self-employed + NPISHs

Market production = ∑ Sales= trade margins + production of goods + provision of services

Market production = ∑ Sales= Trade margins+ production of goods + provision of services

Market production = ∑ Sales= trade margins+ production of goods + provision of services

Non-market production= ∑ Production costs = CMC + FSE + salaries + other operational costs+ consumption of fixed capital

Sources of information: Sources of information: So urces of information:

- SBS. - SBS. - Survey of IPSSs;


facilities

Production = Expenditure Method of estimation: Method of estimation: Method of estimation: Method of estimation:

Production = Production estimates for corporations + general government + sole proprietors and the self-

employed + NPISHs

Market production= ∑ Sales= trade margins + production of goods + provision of services

Non-market production= ∑ production costs= CMC + FSE + Salaries + Other operational costs + Consumption of fixed capital

Market production= ∑ Sales= trade margins+ production of goods + provision of services

Market production= ∑ Sales= trade margins + production of goods+ provision of services

Hidden economy= Estimate based on additional employment for healthcare service providers working outside the tax system

Non-market production= ∑ Production costs = CMC + FSE + salaries + other operational costs + consumption of fixed capital

Sources of information: Sources of information: Sou rces of information: Sources of information:

- SBS; - IGIF; - IRS; - Survey of IPSSs;

- PT-ACS report and financial statements (private social insurance subsystem).


- Estimates for the informal economy based on observations of employment.

- Annual Survey to on Mutual Aid Associations

Regional Health Services of Azores and Madeira

- Report and financial statement of SAMS (pruvite subsystem in health)

- Report and financial statement of INEM

HP.3 - Providers of ambulatory health care



HP.4 – Retail sale and other providers of medical goods

Production = Expenditure

Production = (Out-patient) sales of pharmaceutical items

Sources of information: - Statistics on medicinal products (INFARMED)

HP.4.1 - Dispensing chemists

Production = Expenditure

Production = Part of the final consumption value of products: medical, surgical and orthopaedic equipment and parts (NPCN: 331) and optical, photographic and cinematographic equipment (NPCN: 334)

Sources of information: - Estimates from National Accounts; - Annual Survey on Industrial Production (IAPI).

HP.4.All other sales of medical goods

Production = Expenditure Method of estimation:

Production = Production estimates for NPISHs Market production= ∑ Sales= trade margins + production of goods + provision of services

Non-market production= ∑ Production costs= CMC + FSE + salaries + other operational costs + consumption of fixed capital

Sources of information:

- Survey of IPSSs.

HP.5 - Provision and administration of public health programmes

- Reports and financial statements

HP.6 – General health administration and insurance




Production = Production estimates for general government

Non-market production= ∑ production costs= CMC + FSE + salaries + other operational costs+ consumption of fixed capital


- IGIF;


HP.6.1 – Government administration of health

HP.6.3 - Other social insurance



- ADSE administration production estimates


- ADSE report and financial statement (public social insurance subsystem).

HP.6.4 -Other (private) insurance

Production = Expenditure Method of estimation: Method of estimation:

Production = production estimates for Corporations + NPISHs

Production estimates for PT-ACS and insurance company (healthcare policy) administration

Production estimates for SAMS administration (private social insurance subsystem)

Sources of information: Sources of information:

- PT -ACS report and financial statement (private social insurance subsystem);


- Insurance statistics (ISP).





Non-market production= ∑ production costs= CMC + FSE + salaries + other operational costs+ consumption of fixed capital

Sources of information: - IGIF; - Other reports and financial

statements.

HP.6.9 - All other providers of health administration

HP.7 - Other industries


Production = Production estimates for corporations + general government

Production estimate for medical units (private companies) = No. treatments * Average unit cost

Production estimate for medical units (local authority; other state organisations; state social insurance schemes - GNR, PSP, etc. social services) = No. of treatments * Average unit cost


- Reports and financial statements; - Healthcare statistics;

- Healthcare statistics; - IGIF (estimate of average unit costs);

-Ordinance 132/2003 – Regulations for Tables of Prices for NHS Institutions and Services;

-Ordinance 132/2003 - Regulations for Tables of Prices for NHS Institutions and Services

- IGIF (estimate of average unit costs)

HP.7.1 - Establishments as providers of occupational healthcare services

HP7.2- Households as providers of health care.

Production=Expenditure Production=Expenditure corresponding to the payment of social transfers to the households that take care of their families, disabled, elderly dependant and handicapped.



Data sources:

- Report and financial statement of the Social Security


Production = Production estimates for general government (military and prison hospitals)

Non-market production = ∑ production costs = CMC + FSE + salaries + other operational costs + consumption of fixed capital



HP.7.9 - All other industries as secondary producers of health care

HP.9 - Rest of the world


Production = Production estimates for general government + NPISHs

NHS – Payments for medical care provided to resident units: payments under Community regulations; foreign assistance requested by Portuguese hospitals from foreign hospitals

Amount shared by SAMS and resident units for care provided abroad

ADSE – Payments for medical care provided abroad to residents


- IGIF; - SAMS report and financial statement (private social insurance subsystem).

- Reports and financial statements and detailed cost accounting of the Hospitals-Enterprise

-Regional Health Service of Azores and Madeira

- ADSE report and financial statement.

HHeeaalltthh SSaatteelllliittee AAccccoouunntt MMeetthhooddoollooggiiccaall RReeppoorrtt


AANNNNEEXXEE 1166:: AATTTTRRIIBBUUTTIIOONN OOFF EEXXPPEENNDDIITTUURREE OONN HHEEAALLTTHH CCAARREE BBYY PPRROOVVIIDDEERR IINNDDUUSSTTRRYY AANNDD BBYY SSOOUURRCCEE OOFF FFUUNNDDIINNGG HP.1 - Hospitals

HF.

HF.1.1.1 HF.1.1.2 HF.1.1.3 HF.1.2 HF.2.1 HF.2.2 HF.2.3 HF.2.4 HF.2.5 HF.3

NHS

Public social insurance

subsystems in health


HF.1.2)


Private social insurance subsystems in health

Private insurance

enterprises

Private household out-

of-pocket expenditure

NPISHs (except social

insurance)


health insurance)

Rest of the world

Funding items

Subsidies

(IGIF); Expenditure

(IGIF); Subsidies from

other bodies (IGIF); INE estimates

Amount covered by ADSE (IGIF); Amount covered

by social services

(IGIF);Subsidies of other public entities (IGIF); ADMA/E/FA contributions (Ministry of

Defence statistical

yearbook); Financing on

EOEP (SAMS)

Amount of

health expenditure

considered as deduction on income tax (-

P51)

Contributions and grants -

Regional Social Security Centres;

Expenditure on professional sickness and

risks and other transfers

Financing of other

providers (contributions) and their production under HP.1 (SAMS);

Financing of other providers (contributions)

(PT-ACS); Amount covered by other private

social insurance subsystems (IGIF)

Financing of

production by insurers (SAMS);

Amount covered by insurance companies

(IGIF)

Financing of

production by households

(SAMS); Charges and other (IGIF)


IGIF;Reports and financial

statements and detailed cost

account of the Hospitals-

Enterprise; INE - Other reports and financial statements

IGIF; Ministry of

Defence statistical yearbook;

Report and financial

statement of SAMS

Ministry of Finance

Survey of IPSSs;

Report and financial

statement of Social Security

SAMS report and

financial statement; PT-ACS report and financial

statement; IGIF

SAMS report and financial

statement; IGIF


statement; IGIF



HP.2 - Nursing and residential care facilities

HF.


NHS



Other government units(except

HF.1.2)


Private social insurance


Private insurance

enterprises



NPISHs (except social insurance)


health insurance)

Rest of the world

Funding items

Financing of

different HP.2 providers

(Contributions) (ADSE)

Contributions and grants-

Regional Social Security Centre

Financing of

other providers (Contributions) and their HP.2

production

Enrolments and

dues (IPSS); Financing of


(SAMS); INE estimates


ADSE report and

financial statement

Survey of IPSSs;

Reports and financial

statements

SAMS report and

financial statement

Survey of IPSSs;


statement; INE



HP.3 - Providers of ambulatory health care


NHS Public social insurance


Other government

units (except HF.1.2)




Private insurance enterprises




insurance)

Corporations (other

than health

insurance)

Rest of the

world

RHA

IGIF; INE (Reports and financial

statements)

Amount of ADSE

funding of Integrated Health Centres; amount

covered by social services (IGIF); amount covered by the Armed Forces and the military

(IGIF)

Amount of

health expenditure considered

as deduction on income tax (-P51)

Amount covered by SAMS, IOS CTT,

PT-ACS and other private subsystems

(IGIF)

Amount covered

by insurance companies (IGIF)

Fees (IGIF)

Subsidies of other public entities (IGIF)

Funding items

Private schemes

(SAMS and PT-ACS)

Financing of EOEP (SAMS)

Amount of


as deduction on income tax (-P51)

Estimate of

financing of SAMS and PT-ACS production

Financing of

production by insurers (SAMS and PT-ACS)

Financing of


(SAMS and PT-ACS)



Non-financial

corporation + other

government units

Financing of corporations +

government units outside the NHS – INE estimates of the financing of

the production of provider units outside the NHS; NHS financing of

other healthcare providers (contributions) (IGIF)

Financing of different

HP.3 providers (contributions) (ADSE);

Amount covered by social services (IGIF);

ADMA/E/FA contributions (Ministry of Defence statistical yearbook) ; Subsidies

from other public bodies (IGIF) for other government providers

Amount of


as deduction on income tax (-P51); Financing by other general

government units

Expenditure on

professional sickness and risks and other transfers

Financing of other

providers (contributions)

(SAMS); Financing of other providers

(Contributions) (PT-ACS); Amount

covered by other schemes (IGIF)

INE estimates

Estimate

of financing

of productio

n by IPSS

Estimate

of financing

of production

by corporatio

ns

RHA


statements)

ADSE report and

financial statement; IGIF

Ministry of Finance

IGIF

IGIF

IGIF

Private social

insurance schemes

(SAMS and PT-ACS)

SAMS report and financial statement

Ministry of Finance

SAMS report and

financial statement; PT-ACS report and financial statement

SAMS report and

financial statement PT-ACS report and financial statement;


statement; PT-ACS report and

financial statement


Non-financial

corporations + other

government units


statements)

ADSE report and

financial statement IGIF; Ministry of

Defence statistical yearbook

Ministry of Finance;

INE (Reports

and financial

statements)

SAMS report and

financial statement; PT-ACS report and financial statement;

IGIF

INE

Survey

of IPSSs

SBS



HP.4 - Retail sale and other providers of medical g oods HF.


NHS




HF.1.2)




Private insurance

enterprises

Private household out-of-pocket expenditure


insurance)


health insurance)

Rest of the world

HP.4.1

Invoicing of

private dispensing chemists

Costs of ADSE + Ministry of Justice social insurance

systems (INFARMED); Contributions (ADMA/E/FA)

Amount of

health expenditure

considered as deduction on income tax (-

P51)

Expenditur

e on professional sickness and risks and other transfers

Total social insurance subsystem

charges (INFARMED) –


subsystems (ADSE + Ministry

of Justice + ADMA/E/FA)

Estimate of insurance company

funding destined to finance

HP.4.1

Household costs

(for private + public social insurance

subsystems + NHS) + market NPM +

other market (INFARMED)

Funding items

HP.4.2

Invoicing of

supplementary therapeutic equipment

Contributions (ADMA/E/FA); Contributions

(ADSE)

Amount of health

expenditure considered as deduction on income tax (-

P51)

Expenditur

e on professional sickness and risks and other transfers

Contributions

(PT-ACS); Contributions

(SAMS)

Estimate of amount of

financing from insurers

destined to fund HP.4.2

INE estimates

HP.4.1

IGIF;

INFARMED

INFARMED;

Ministry of Defence statistical yearbook

Ministry of Finance

Report and

financial statement

of the Social

Security

INFARMED; Ministry of Defence statistical yearbook

INE estimates;

ISP

INFARMED


HP.4.2

IGIF

ADSE report and

financial statement; Ministry of Defence statistical yearbook

Ministry of Finance

Report and

financial statement

of the Social

Security

PT-ACS report and financial

statement; SAMS report and financial

statement

INE estimates;

ISP

INE

NPM - Non-prescription medicines



HP.5 -Provision and administration of public health programmes

HF. HF.1.1.1 HF.1.1.2 HF.1.1.3 HF.1.2 HF.2.1 HF.2.2 HF.2.3 HF.2.4 HF.2.5 HF.3

NHS




HF.1.2)




Private insurance

enterprises

Private household

out-of-pocket expenditure



health insurance) Rest of the world

Funding items Estimates IGIF

Contributions and grants - Regional Social Security

Centre

INE estimates


IGIF

Survey of IPSSs;

reports and financial

statements

INE

HP.6 – General health administration and insurance


NHS



Other government units (except HF.1.2)




Private insurance

enterprises

Private household out-of-pocket expenditure

NPISHS (except as de social insurance)

Corporations (other than health insurance)

Rest of the world

Funding items HP6.1- Estimates INE

HP6.3- Estimates of financing of administrative services of ADSE

HP6.1- Estimates

INE; HP6.9- Estimates INE

HP.6.4 – Estimate of financing of the administration of

other private social insurance subsystems in

health

HP.6.4 –

Estimate of company

funding of the administration

of health insurance

HP6.3- Estimates of financing of administrative services of ADSE


INE (Reports and financial statements)

Reports and financial statements of ADSE

INE (Reports and financial statements)

Reports and

financial statements SAMS;


statements ACS-PT

Insurance statistics (ISP)

Reports and financial statements of ADSE



HP.7 - Other industries

HF.


NHS



Other government units (except HF.1.2)




Private insurance

enterprises





health insurance) Rest of the world

Funding items

Funding = estimated output of HP.7.1; Funding = estimated output of HP.7.9

Financing = estimated

amount for ou tput for HP7.2

Private social

insurance subsystems which fund

HP.7.1 production

Financing =

estimated output of HP.7.1

Financing =

estimated output of HP.7.1


Healthcare statistics; IGIF

(unit costs); INE (reports and

financial statements)


statements of Social Security

INE (reports and

financial statements)

Healthcare

statistics; IGIF (unit costs); INE

(reports and financial

statements)

Healthcare

statistics; IGIF (unit costs); INE

(reports and financial

statements)



HP.9 - Rest of the world


NHS




HF.1.2)




Private insurance

enterprises




Corporations (other than health insurance)

Rest of the world

Funding items

Payments for medical care provided to resident units:

payments under EU regulations; foreign

assistance requested by Portuguese hospitals from

foreign hospitals

Payments for medical care

provided abroad to

residents, due to lack of technical resources

Amount shared by

SAMS and resident units for

care provided abroad


IGIF; Reports and financial

statements and detailed cost account of the

Hospitals-Enterprise; Regional Health Services of

Azores and Madeira

ADSE report and financial

statement

SAMS report and

financial statement



AANNNNEEXXEE 1177:: SSoouurrcceess ooff iinnffoorrmmaatt iioonn uusseedd iinn aatt tt rr iibbuutt iinngg eexxppeennddii ttuurree oonn hheeaall tthh ccaarree bbyy pprroovviiddeerr iinndduussttrryy aanndd bbyy ffuunncctt iioonn

HP.4 - Retail sale and other providers of medical

goods HP.6 – General health administration and insurance

HP.1 HP.2 HP.3 HP.4.1 HP.4.2-4.9 HP.5 HP.6.1 HP.6.3 HP.6.4 HP.6.9 HP.7 HP.9

Hospitals Nursing and

residential care facilities

Providers of ambulatory health care

Dispensing chemists

All other sales of medical goods

Provision and administration

of public health

programmes

Government administration

of health

Other social insurance

Other (private)

insurance

All other providers of

health administration

Other industries

Rest of the world

HC

HC. 1.1; 2.1;

HC.3.1

.

.

.

.

HC.7

Sources of

information: IGIF; SBS; Survey of

IPSSs

Sources of

information: SBS; Survey of IPSSs; SAMS

report and financial

statement; ADSE report and financial

statement

Sources of

information: SBS; IGIF;

INE (reports and financial statements);

PT-ACS report and financial

statement; SAMS report and financial statement; Survey of

IPSSs

Total value of

HP.4.1 imputed to

HC.5.1

Total value of HP.4.2 -

HP.4.9 imputed to

HC.5.2

Total value of HP.5 imputed

to HC.6

Total value of HP.6 (HP.6.1; 6.3; 6.4; 6.9) imputed to HC.7

HP.7.1 – Total

value imputed to

HC.6; HP7.2- imputed

amounts to HC1.4, HC2.4

e HC3.3; HP.7.9

(military and prison

hospitals) - Sources of

information: IGIF

Sources of

information: IGIF



AANNNNEEXXEE 1188:: SSoouurrcceess ooff iinnffoorrmmaatt iioonn uusseedd ttoo aall llooccaattee HHFF bbyy HHCC iinn rreellaatt iioonn ttoo ddii ff ffeerreenntt HHPPss

HF

NHS



Other general government units (except HF.1.2)


Private social

insurance subsystems in

health

Private insurance

enterprises

Private household

out-of-pocket expenditure

NPISHs (other than

social insurance)


health insurance)

Rest of the world

HP HC Total current

expenditure on health care

HF1.1.1 HF1.1.2 HF1.1.3 HF.1.2 HF.2.1 HF.2.2 HF.2.3 HF.2.4 HF.2.5 HF.3

HC. 1.1; 2.1;

HC.1.1, 2.1; HP.1

HC.3.1 HC.3.1; HP.1 . .

HP.1

HC.7 HC.7; HP.1

Financial

adjustments =

Expenditure

IGIF structure;

SBS; Reports and financial

statements and detailed cost

account of the Hospitals-Enterprise

Amount of health

expenditure considered as

deduction on income tax (-P51) broken-down according to

the inicial structure of household

expenditure

Survey of

IPSS structure;


statement of the social security

IGIF

structure

IGIF

structure; SBS

IGIF

structure (fees + other)

HP.1; HF.1.1.1 HP.1; HF.1.1.2 HP.1; HF.1.1.3 HP.1; HF.1.2 HP.1; HF.2.1 HP.1;

HF.2.2 HP.1; HF.2.3 HP.1; HF.2.4 HP.1; HF.2.5 HP.1;

HF.3



NHS




HF.1.2)




Private insurance

enterprises



NPISHs (other than

social insurance)


health insurance)

Rest of the world

HP HC Total current



HC. 1.1; 2.1;

HC.1.1, 2.1; HP.2

HC.3.1 HC.3.1; HP.2

. .

HP.2

HC.7 HC.7; HP.2

Part of the

funding imputed to HC.3.1 –

Homes and rest homes; Another part attributed to

HC.3.3 - Home care (Source of

information: ADSE)

Survey of

IPSS structure; Reports

and financial


Total value imputed to

HC.3.1 (financing of

own production – homes for the

elderly and other providers -

contributions) (Source of

information: SAMS report and financial statement)

Survey of

IPSS structure

Financial

adjustments =

Expenditure on HC.3.1 and HC.4

HP.2;

HF.1.1.1 HP.2; HF.1.1.2 HP.2; HF.1.1.3 HP.2; HF.1.2 HP.2; HF.2.1 HP.2;

HF.2.2 HP.2; HF.2.3 HP.2; HF.2.4 HP.2; HF.2.5 HP.2;

HF.3



NHS




HF.1.2)




Private insurance

enterprises



NPISHs (other than social insurance)


health insurance)

Rest of the world

HP HC

Total current



HC. 1.1; 2.1;

HC.1.1, 2.1; HP.3

HC.3.1

HC.3.1; HP.3

. .

. .

HP.3

HC.7 HC.7; HP.3

RHA- IGIF structure;

Other

providers (Corporations)

– SBS structure;

Other

government providers

belonging to the NHS -

IGIF structures


Other providers (Corporations) -

Contributions structure;

Other providers

of General Government included in

NHS- Structures IGIF

Production of private social

insurance schemes - Production structure by

function within sub systems

Amount of health

expenditure considered as deduction on income tax (-P51) broken-

down according to

the initial structure of household

expenditure

Imputation of the

expenditure by

function of health

care-Reports

and financial statemen

ts of Social

Security


Other


– Contributions

structures;

Production - Production structure by

function within subsystems


Other

providers (Corporation

s) – SBS structure;

Production of private

social insurance

sub-systems in health-

Production structure by

function within sub-

systems


Other


– Financial adjustments = Expenditure;

Production of private social

insurance subsystems in

health - Production structure by

function;

Other government providers -

IGIF structure;

Other

providers (Corporations) - Survey

of IPSS structure

Other

providers (Corporation

s) - total imputed to HC.1.3;2.3

HP.3; HF.1.1.1 HP.3; HF.1.1.2 HP.3; HF.1.1.3 HP.3; HF.1.2 HP.3; HF.2.1 HP.3; HF.2.2 HP.3; HF.2.3 HP.3; HF.2.4 HP.3; HF.2.5 HP.3;

HF.3



NHS




HF.1.2)


Private social


in health

Private insurance

enterprises

Private household

out-of-pocket

expenditure

NPISHs (other than

social insurance)


health insurance)

Rest of the

world

HP HC Total current



HC. 1.1; 2.1; HC.1.1, 2.1; HP.4

HC.3.1 HC.3.1; HP.4

. .

. .

. .

. .

HP.4

HC.7 HC.7; HP.4

Total value of HP.4.1 imputed to

HC.5.1; Total value of HP.4.2 imputed to

HC.5.2



HC.5.2


HC.5.1; Total value of HP.4.2

imputed to HC.5.2

Reports

and financial




HC.5.2

Total

value of HP.4.1 imputed

to HC.5.1;

Total value of HP.4.2 imputed

to HC.5.2

Total


to HC.5.1; Total


to HC.5.2

HP.4;

HF.1.1.1 HP.4;

HF.1.1.2 HP.4; HF.1.1.3 HP.4;

HF.1.2 HP.4; HF.2.1 HP.4;

HF.2.2 HP.4; HF.2.3

HP.4; HF.2.4

HP.4; HF.2.5

HP.4; HF.3

NHS




HF.1.2)




Private insurance

enterprises

Private household

out-of-pocket

expenditure

NPISHs (other than

social insurance)


health insurance)

Rest of the world

HP HC Total current



HC. 1.1; 2.1; HC.1.1, 2.1; HP.5

HC.3.1 HC.3.1; HP.5 . .

HP.5

HC.7 HC.7; HP.5

Total

value of HP.5

imputed to HC.6

Total value of

HP.5 imputed to

HC.6

HP.5;

HF.1.1.1 HP.5;

HF.1.1.2 HP.5; HF.1.1.3 HP.5; HF.1.2 HP.5; HF.2.1 HP.5;

HF.2.2 HP.5; HF.2.3

HP.5; HF.2.4 HP.5; HF.2.5 HP.5;

HF.3



HF

NHS




HF.1.2)




Private insurance

enterprises

Private household

out-of-pocket

expenditure

NPISHs (other than

social insurance


health insurance)

Rest of the world

HP HC

Total current

expenditure on health

care


HC. 1.1; 2.1; HC.1.1, 2.1; HP.6

HC.3.1 HC.3.1; HP.6

. .

HP.6

HC.7 HC.7; HP.6


HC.7


HC.7

Total value of HP.6.1 and

HP6.9 imputed to

HC.7


HC.7

Total

value of HP.6.4 imputed to HC.7

Total

value of HP.6.3

imputed to HC.7

Total of

HP.6 (HP.6.1; 6.3;

6.4; 6.9) imputed to

HC.7

HP.6;

HF.1.1.1 HP.6;

HF.1.1.2 HP.6; HF.1.1.3 HP.6; HF.1.2 HP.6; HF.2.1

HP.6; HF.2.2

HP.6; HF.2.3 HP.6; HF.2.4 HP.6; HF.2.5

HP.6; HF.3

HF

NHS





Private social


in health

Private insurance

enterprises

Private household

out-of-pocket

expenditure

NPISHs (other than

social insurance


health insurance)

Rest of the world

HP HC

Total current expenditure on health

care


HC. 1.1; 2.1; HC.1.1, 2.1; HP.7

HC.3.1 HC.3.1; HP.7

. .

. .

. .

. .

HP.7

HC.7 HC.7; HP.7

HP.7.1 –


HC.6; HP7.9 (military

hospitals + prison

hospital) – Structure

IGIF

HP.7.2 –Values

imputed to HC1.4, HC2.4,

HC3.3; - Report

and financial

statement of the Social

HP.7.1 –


HC.6

HP.7.1 –

Total value

imputed to HC.6

HP.7.1 –


HC.6



Security

HP.7;

HF.1.1.1 HP.7; HF.1.1.2 HP.7; HF.1.1.3 HP.7; HF.1.2 HP.7; HF.2.1

HP.7; HF.2.2

HP.7; HF.2.3

HP.7; HF.2.4 HP.7; HF.2.5

HP.7; HF.3

HF

NHS







Private insurance

enterprises

Private household

out-of-pocket

expenditure

NPISHs (other than

social insurance)


health insurance)

Rest of the world

HP HC

Total current expenditure on health

care


HC. 1.1; 2.1; HC.1.1, 2.1; HP.9

. . HP.9

HC.7 HC.7; HP.9

IGIF structure

IGIF structure

IGIF

structure

HP.9;

HF.1.1.1 HP.9;

HF.1.1.2 HP.9; HF.1.1.3 HP.9;

HF.1.2 HP.9; HF.2.1 HP.9;

HF.2.2 HP.9; HF.2.3

HP.9; HF.2.4

HP.9; HF.2.5 HP.9; HF.3

Documents

PORTUGAL HEALTH SATELLITE ACCOUNTS